Provider Demographics
NPI:1518127620
Name:PATEL, SHAILESH MANSUKH (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:MANSUKH
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4250 BETHEL RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8737
Practice Address - Country:US
Practice Address - Phone:901-516-1290
Practice Address - Fax:901-516-1220
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20654207R00000X, 208M00000X
TN2518207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199447003Medicaid
MSP01240977OtherRAILROAD MEDICARE
TN4354878OtherBCBS
MS04776524Medicaid
TNQ007100Medicaid
TN10311I9622Medicare PIN
AR199447003Medicaid