Provider Demographics
NPI:1437108800
Name:PATEL, ANIL C (MD, MBA)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 WARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1828
Mailing Address - Country:US
Mailing Address - Phone:931-551-9605
Mailing Address - Fax:931-503-0386
Practice Address - Street 1:280 WARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1828
Practice Address - Country:US
Practice Address - Phone:931-551-9605
Practice Address - Fax:931-503-0386
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023155Medicaid
TNA98703Medicare UPIN
TN3023155Medicare ID - Type Unspecified