Provider Demographics
NPI:1346235215
Name:PATEL, SHAILESH RAVJIBHAI (MD)
Entity Type:Individual
Prefix:
First Name:SHAILESH
Middle Name:RAVJIBHAI
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 1:5969 E BROAD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1546
Mailing Address - Country:US
Mailing Address - Phone:614-367-0585
Mailing Address - Fax:614-367-0599
Practice Address - Street 1:5969 E BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:614-367-0585
Practice Address - Fax:614-367-0599
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062270P207RC0000X
OH35.062270207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2174687Medicaid
PA0815911Medicare ID - Type Unspecified
OH2174687Medicaid