Provider Demographics
NPI:1548231616
Name:PATEL, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
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 1:1913 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2857
Mailing Address - Country:US
Mailing Address - Phone:765-825-1165
Mailing Address - Fax:
Practice Address - Street 1:1913 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2857
Practice Address - Country:US
Practice Address - Phone:765-827-1903
Practice Address - Fax:765-827-1918
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028231208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100114640Medicaid
IN231680IMedicare PIN
IN230800AMedicare PIN
C24703Medicare UPIN