Provider Demographics
NPI:1467544817
Name:PATEL, ASHA H (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:H
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 WEST THIRTEEN MILE ROAD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-7977
Mailing Address - Fax:
Practice Address - Street 1:3601 WEST THIRTEEN MILE ROAD
Practice Address - Street 2:SUITE 236
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106312910OtherBCBS OF MI
MI3420896Medicaid
MIF76555Medicare UPIN
MI0829228Medicare ID - Type UnspecifiedMEDICARE