Provider Demographics
NPI:1538324355
Name:INDU B PATEL MD PC
Entity Type:Organization
Organization Name:INDU B PATEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDU
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-464-7032
Mailing Address - Street 1:7105 METROPOLITAN BLVD
Mailing Address - Street 2:P.O. BOX 308
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1495
Mailing Address - Country:US
Mailing Address - Phone:636-464-7032
Mailing Address - Fax:636-464-5877
Practice Address - Street 1:7105 METROPOLITAN BLVD
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1495
Practice Address - Country:US
Practice Address - Phone:636-464-7032
Practice Address - Fax:636-464-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D52174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201974219Medicaid