Provider Demographics
NPI:1437123965
Name:PATEL, DEEPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 ARCHWAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-8835
Mailing Address - Country:US
Mailing Address - Phone:949-701-2526
Mailing Address - Fax:
Practice Address - Street 1:26212 DIMENSION DR
Practice Address - Street 2:STE 250
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7810
Practice Address - Country:US
Practice Address - Phone:949-855-1887
Practice Address - Fax:949-855-3213
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079223P207R00000X
CAC140704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2303608Medicaid
OHPA4055933Medicare PIN
OHG60585Medicare UPIN