Provider Demographics
NPI:1508825183
Name:PATEL, MUKESH R (MD)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1551 JANMAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5606
Mailing Address - Country:US
Mailing Address - Phone:678-344-8900
Mailing Address - Fax:678-666-5201
Practice Address - Street 1:501 CROWNPOINTE WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7702
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:678-666-5201
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA021882208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00304818AMedicaid
GA000304818BMedicaid
E00856Medicare UPIN
GA00304818AMedicaid