Provider Demographics
NPI:1386816460
Name:SUDHA R PATEL MD PC
Entity Type:Organization
Organization Name:SUDHA R PATEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-728-2300
Mailing Address - Street 1:49848 COOKE AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2885
Mailing Address - Country:US
Mailing Address - Phone:734-459-4128
Mailing Address - Fax:734-728-1400
Practice Address - Street 1:34210 GLENWOOD AVE.
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5439
Practice Address - Country:US
Practice Address - Phone:734-728-2300
Practice Address - Fax:734-728-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1874675Medicaid
MIA73624Medicare UPIN