Provider Demographics
NPI:1437125770
Name:PATEL, TEJAS I (MD)
Entity Type:Individual
Prefix:
First Name:TEJAS
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10061 RIVERSIDE DR
Mailing Address - Street 2:#167
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2560
Mailing Address - Country:US
Mailing Address - Phone:818-842-6400
Mailing Address - Fax:818-842-9400
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:STE. 412
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:818-842-6400
Practice Address - Fax:818-842-9400
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA88498207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A884980Medicaid
CA00A884980Medicaid
CAWA88498BMedicare PIN
CAWA88498AMedicare PIN