Provider Demographics
NPI:1366027971
Name:PATEL, DHRUVIT HARSHADBHAI (MBBS, PA-C)
Entity Type:Individual
Prefix:
First Name:DHRUVIT
Middle Name:HARSHADBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MBBS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5765 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9717
Mailing Address - Country:US
Mailing Address - Phone:908-525-6661
Mailing Address - Fax:
Practice Address - Street 1:5765 BLUE SKY DR
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-9717
Practice Address - Country:US
Practice Address - Phone:908-525-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003397A363A00000X
261QS1000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program