Provider Demographics
NPI:1467437160
Name:PATEL, RAJNIKANT MANIBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJNIKANT
Middle Name:MANIBHAI
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 1:1636 BALMORAL WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2416
Mailing Address - Country:US
Mailing Address - Phone:440-997-6585
Mailing Address - Fax:440-997-6586
Practice Address - Street 1:2422 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4985
Practice Address - Country:US
Practice Address - Phone:440-997-6585
Practice Address - Fax:440-997-6586
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-9525-P208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0538001Medicaid
OH0538001Medicaid
34-1541470OtherEIN
OHPA058680Medicare ID - Type Unspecified