Provider Demographics
NPI:1407270580
Name:PATEL, BHAVESH BABULAL
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:BABULAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1002
Mailing Address - Country:US
Mailing Address - Phone:269-345-8507
Mailing Address - Fax:269-345-8516
Practice Address - Street 1:5020 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1002
Practice Address - Country:US
Practice Address - Phone:269-345-8507
Practice Address - Fax:269-345-8516
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist