Provider Demographics
NPI:1467474593
Name:PRABHU B. PATIL,M.D.,P.A
Entity Type:Organization
Organization Name:PRABHU B. PATIL,M.D.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHU
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:713-697-7166
Mailing Address - Street 1:150 W PARKER RD
Mailing Address - Street 2:STE. 704
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-2951
Mailing Address - Country:US
Mailing Address - Phone:713-697-7166
Mailing Address - Fax:713-697-7606
Practice Address - Street 1:150 W PARKER RD
Practice Address - Street 2:STE. 704
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-2951
Practice Address - Country:US
Practice Address - Phone:713-697-7166
Practice Address - Fax:713-697-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152148601Medicaid
TXD67526Medicare UPIN
TX152148601Medicaid