Provider Demographics
NPI:1487630505
Name:PATEL, KANU J (MD)
Entity Type:Individual
Prefix:DR
First Name:KANU
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:45 MEDICAL ARTS CT
Mailing Address - Street 2:STE 1
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3871
Mailing Address - Country:US
Mailing Address - Phone:334-382-5564
Mailing Address - Fax:334-382-9289
Practice Address - Street 1:45 MEDICAL ARTS CT
Practice Address - Street 2:STE 1
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3871
Practice Address - Country:US
Practice Address - Phone:334-382-5564
Practice Address - Fax:334-382-9289
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL19252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009982410Medicaid
AL110234290OtherRAILROAD MEDICARE
G10028Medicare UPIN
AL051506986Medicare PIN