Provider Demographics
NPI:1477582930
Name:PATEL, SHIRISHKUMAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRISHKUMAR
Middle Name:N
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 1:1501 COPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1797
Mailing Address - Country:US
Mailing Address - Phone:270-993-0755
Mailing Address - Fax:
Practice Address - Street 1:1201 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9811
Practice Address - Country:US
Practice Address - Phone:270-417-4700
Practice Address - Fax:270-417-4709
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64315872Medicaid
IN200063470Medicaid
IN200063470Medicaid
KY64315872Medicaid
KY000000045767OtherANTHEM BC/BS
KY64315872Medicaid
KY610890594OtherEIN