Provider Demographics
NPI:1568001196
Name:PATEL, ASHISHKUMAR A
Entity Type:Individual
Prefix:
First Name:ASHISHKUMAR
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7172 MEADOWBROOK DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3552
Mailing Address - Country:US
Mailing Address - Phone:847-505-8008
Mailing Address - Fax:248-856-1242
Practice Address - Street 1:7172 MEADOWBROOK DR UNIT 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3552
Practice Address - Country:US
Practice Address - Phone:847-505-8008
Practice Address - Fax:248-856-1242
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist