Provider Demographics
NPI:1528001575
Name:PATEL, ASHOK K (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:K
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 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:14500 99TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4730
Practice Address - Country:US
Practice Address - Phone:763-898-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28246207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169148OtherUCARE #
MN10241OtherNDBS #
MN0402618OtherMEDICA #
MN20249PAOtherMNBS #
MNMN100016OtherLHS/BANNERHEALTH #
MNHP19585OtherHEALTHPARTNERS #
MN13408Medicaid
MN844575OtherAMERICA'S PPO/ARAZ #
MN628070600Medicaid
MNDA9021015705OtherPREFERRED ONE #
MN13408Medicaid
MN10241OtherNDBS #
MN110081808Medicare ID - Type UnspecifiedRR MEDICARE #
MN628070600Medicaid