Provider Demographics
NPI:1538304597
Name:PATEL, NISHA B (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:555 DR. MICHAEL DEBAKEY DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5700
Mailing Address - Country:US
Mailing Address - Phone:337-439-0762
Mailing Address - Fax:337-439-9253
Practice Address - Street 1:555 DR. MICHAEL DEBAKEY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5700
Practice Address - Country:US
Practice Address - Phone:337-439-0762
Practice Address - Fax:337-439-9253
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2020-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.208021207RG0100X
TXP2912207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2413309Medicaid
CAEZ106ZMedicare PIN