Provider Demographics
NPI:1528393147
Name:PATEL MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PATEL MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANTILAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-397-1342
Mailing Address - Street 1:525 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3206
Mailing Address - Country:US
Mailing Address - Phone:219-397-1342
Mailing Address - Fax:219-397-2580
Practice Address - Street 1:525 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3206
Practice Address - Country:US
Practice Address - Phone:219-397-1342
Practice Address - Fax:219-397-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132990Medicaid
IN200132990Medicaid
F88586Medicare UPIN