Provider Demographics
NPI:1356327647
Name:PATEL, MONIKA J (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6465 E BROAD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1576
Mailing Address - Country:US
Mailing Address - Phone:614-322-9640
Mailing Address - Fax:614-322-9641
Practice Address - Street 1:6465 E BROAD ST
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1576
Practice Address - Country:US
Practice Address - Phone:614-322-9640
Practice Address - Fax:614-322-9641
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-06-4075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0551862Medicaid
OH0551862Medicaid
OH0817083Medicare PIN