Provider Demographics
NPI:1396856811
Name:PATEL, VASUMATI D (MD)
Entity Type:Individual
Prefix:
First Name:VASUMATI
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-232-0564
Mailing Address - Fax:812-242-3842
Practice Address - Street 1:221 S 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4214
Practice Address - Country:US
Practice Address - Phone:812-232-0564
Practice Address - Fax:812-242-3842
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026918A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089587OtherANTHEM
166917OtherHEALTHLINK
0182853OtherUS DEPT OF LABOR
4062087OtherAETNA
01416OtherCIGNA
351904269104OtherCARESOURCE MEDICAID
IL4950162068OtherILLINOIS PUBLIC AID
N280706OtherHARMONY HEALTH PLAN IND
IN859910AAMedicare PIN
0182853OtherUS DEPT OF LABOR
4062087OtherAETNA