Provider Demographics
NPI:1477512309
Name:PATEL, KIRIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRIT
Middle Name:S
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 1:2120 BERT KOUNS LOOP
Mailing Address - Street 2:STE F
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-686-1668
Mailing Address - Fax:318-686-5821
Practice Address - Street 1:2120 BERT KOUNS LOOP
Practice Address - Street 2:STE F
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3351
Practice Address - Country:US
Practice Address - Phone:318-686-1668
Practice Address - Fax:318-686-5821
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL05690R207RP1001X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1322954Medicaid
LAB89737Medicare UPIN
LA54530Medicare ID - Type Unspecified