Provider Demographics
NPI:1568024248
Name:PATEL, KAVIN MAHESH
Entity Type:Individual
Prefix:
First Name:KAVIN
Middle Name:MAHESH
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 1:1007 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-6000
Mailing Address - Country:US
Mailing Address - Phone:901-490-3776
Mailing Address - Fax:
Practice Address - Street 1:99 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-6305
Practice Address - Country:US
Practice Address - Phone:901-840-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist