Provider Demographics
NPI:1518180512
Name:PATEL, SMITA V (MD)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:V
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 1:922 EAST UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4466
Mailing Address - Country:US
Mailing Address - Phone:574-968-0011
Mailing Address - Fax:574-968-0012
Practice Address - Street 1:922 EAST UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4466
Practice Address - Country:US
Practice Address - Phone:574-968-0011
Practice Address - Fax:574-968-0012
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063933A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200867110Medicaid
IN000000581215OtherBCBS
IN187670MMedicare PIN
IN000000581215OtherBCBS
IN257300AMedicare PIN
IN233880JMedicare PIN