Provider Demographics
NPI:1518114594
Name:PATEL, PAWAN D (MD)
Entity Type:Individual
Prefix:
First Name:PAWAN
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HENNEPIN AVE
Mailing Address - Street 2:APT 301
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1725
Mailing Address - Country:US
Mailing Address - Phone:773-971-4550
Mailing Address - Fax:
Practice Address - Street 1:1300 ANNE ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5103
Practice Address - Country:US
Practice Address - Phone:218-333-5519
Practice Address - Fax:218-333-4961
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN54548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine