Provider Demographics
NPI:1467400580
Name:PATEL, NILESH HARIBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:NILESH
Middle Name:HARIBHAI
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 1:5640 MONT PELIER CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8022
Mailing Address - Country:US
Mailing Address - Phone:312-320-0112
Mailing Address - Fax:
Practice Address - Street 1:1303 AZALEA CT STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5765
Practice Address - Country:US
Practice Address - Phone:843-692-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0757622085R0204X
AZ564422085R0204X
CAG757622085R0204X
SC932002085R0204X
IL0361060112085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0935687403Medicaid
ILP00463387OtherMEDICARE RAILROAD
IL206147OtherMEDICARE GROUP
IL3625139096019701OtherCDH HFS GROUP PAYEE ID
IL3625139096019701OtherCDH HFS GROUP PAYEE ID
ILP00463387OtherMEDICARE RAILROAD