Provider Demographics
NPI:1467461426
Name:PATEL, SANTOSH CHANDRAKANT (MD)
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:CHANDRAKANT
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:PO BOX 730990
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0990
Mailing Address - Country:US
Mailing Address - Phone:972-791-1224
Mailing Address - Fax:972-692-7965
Practice Address - Street 1:2625 BOLTON BOONE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2011
Practice Address - Country:US
Practice Address - Phone:972-283-1516
Practice Address - Fax:972-283-1448
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3352207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1877979 01Medicaid
TX8BE521OtherBCBS
TX8B7172OtherBCBS
TX8K6302Medicare PIN
TX8F8680Medicare PIN
TX8B7172OtherBCBS
TX8BE521OtherBCBS
TXP00389345Medicare PIN
TX8J2705Medicare PIN