Provider Demographics
NPI:1467487264
Name:PATEL, KANTILAL LALLUBHAT
Entity Type:Individual
Prefix:
First Name:KANTILAL
Middle Name:LALLUBHAT
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROWE ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5238
Mailing Address - Country:US
Mailing Address - Phone:478-272-0353
Mailing Address - Fax:478-272-0363
Practice Address - Street 1:106 ROWE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5238
Practice Address - Country:US
Practice Address - Phone:478-272-0353
Practice Address - Fax:478-272-0363
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00199339AMedicaid
GA00199339AMedicaid