Provider Demographics
NPI:1467747527
Name:PATEL, PRATIKKUMAR (MDMPH)
Entity Type:Individual
Prefix:DR
First Name:PRATIKKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MDMPH
Other - Prefix:DR
Other - First Name:PRATIK
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDMPH
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:SUITE 3.137
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 PENNSYLVANIA AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3390
Practice Address - Country:US
Practice Address - Phone:304-388-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27506208000000X, 2080P0206X
TXBP10040436390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program