Provider Demographics
NPI:1558360669
Name:PATEL, GHANSHYAM N (MD)
Entity Type:Individual
Prefix:DR
First Name:GHANSHYAM
Middle Name:N
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:PO BOX 380476
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0066
Mailing Address - Country:US
Mailing Address - Phone:586-228-7568
Mailing Address - Fax:586-228-7644
Practice Address - Street 1:18645 CANAL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5822
Practice Address - Country:US
Practice Address - Phone:586-228-7568
Practice Address - Fax:586-228-7644
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP040631207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3279758Medicaid
MIMI2759Medicare PIN
MIA74004Medicare UPIN
MI0500496Medicare ID - Type Unspecified