Provider Demographics
NPI:1548409782
Name:CHETAN PATEL MD LLC
Entity Type:Organization
Organization Name:CHETAN PATEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-354-0944
Mailing Address - Street 1:7879 AUBURN RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9611
Mailing Address - Country:US
Mailing Address - Phone:440-354-0944
Mailing Address - Fax:440-354-2043
Practice Address - Street 1:7879 AUBURN RD STE 1A
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9611
Practice Address - Country:US
Practice Address - Phone:440-354-0944
Practice Address - Fax:440-354-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070370261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH9381321Medicare PIN