Provider Demographics
NPI:1497778682
Name:PATEL, PRAKASH B (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1011 E SAINT MAARTENS DR
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-0185
Mailing Address - Fax:816-364-6225
Practice Address - Street 1:1011 E SAINT MAARTENS DR
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-0185
Practice Address - Fax:816-364-6225
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3A80207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201272606Medicaid
MO201272606Medicaid
MOG204436Medicare ID - Type Unspecified