Provider Demographics
NPI:1336131812
Name:PATEL, AMIT INDRAVADAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:INDRAVADAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 BOWSER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4301
Mailing Address - Country:US
Mailing Address - Phone:214-604-5440
Mailing Address - Fax:469-440-7400
Practice Address - Street 1:2301 MARSH LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8497
Practice Address - Country:US
Practice Address - Phone:469-999-4519
Practice Address - Fax:469-440-7400
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3682207VF0040X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7323792OtherAETNA
TX1818411Medicaid
TX8DM546OtherBCBS PROVIDER #
TX8DM546OtherBCBS PROVIDER #
TXI60630Medicare UPIN