Provider Demographics
NPI:1417265349
Name:PATEL FAMILYMEDICINE
Entity Type:Organization
Organization Name:PATEL FAMILYMEDICINE
Other - Org Name:PLYMOUTH FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-936-3178
Mailing Address - Street 1:1904 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-7828
Mailing Address - Country:US
Mailing Address - Phone:574-936-3178
Mailing Address - Fax:574-936-1084
Practice Address - Street 1:1625 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-255-1400
Practice Address - Fax:574-485-1781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED SURGEONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063921A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty