Provider Demographics
NPI:1417950510
Name:PATIL, SANJAY J (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:J
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6905 BURLINGTON PIKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1618
Mailing Address - Country:US
Mailing Address - Phone:859-331-0774
Mailing Address - Fax:859-282-7324
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:BALDWIN BLDG - 5 SOUTH
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-1954
Practice Address - Fax:513-585-0607
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34438207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50024716Medicaid
KY64344831Medicaid
OH2121297Medicaid
KY00954014Medicare PIN
KYP400036372Medicare PIN
KY0551803Medicare PIN
F10602Medicare UPIN
KY64344831Medicaid