Provider Demographics
NPI:1346277936
Name:PATEL, GHANSHYAMBHAI K (MD)
Entity Type:Individual
Prefix:
First Name:GHANSHYAMBHAI
Middle Name:K
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 1:518 SW WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3540
Mailing Address - Country:US
Mailing Address - Phone:859-492-5920
Mailing Address - Fax:386-752-8991
Practice Address - Street 1:518 SW WINDSOR DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3540
Practice Address - Country:US
Practice Address - Phone:859-492-5920
Practice Address - Fax:386-752-8991
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY315862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31586Medicaid
KYP00022291OtherRR MEDICARE
KY31586Medicaid
KY3341063Medicare PIN