Provider Demographics
NPI:1518159599
Name:PATEL, ANAND D (MD)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19275 W CAPITOL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2742
Mailing Address - Country:US
Mailing Address - Phone:262-701-7040
Mailing Address - Fax:262-701-4978
Practice Address - Street 1:19275 W CAPITOL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2742
Practice Address - Country:US
Practice Address - Phone:262-701-7040
Practice Address - Fax:262-701-4978
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61806-20207YX0007X, 207YX0007X
NY245536390200000X
TXN2714207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK100139006Medicare PIN
WIK400139036Medicare PIN