Provider Demographics
NPI:1518064278
Name:PATEL, AMI N (MD)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:STE 340
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4072
Mailing Address - Country:US
Mailing Address - Phone:818-543-7574
Mailing Address - Fax:818-956-7609
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE 340
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-543-7574
Practice Address - Fax:818-956-7609
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88993207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88993OtherAMI PATEL-LICENSE NO
CABK694Medicare PIN