Provider Demographics
NPI:1568539054
Name:PATEL, KAUSHIK V (MD)
Entity Type:Individual
Prefix:DR
First Name:KAUSHIK
Middle Name:V
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 1:1555 EAST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1153
Mailing Address - Country:US
Mailing Address - Phone:530-242-4683
Mailing Address - Fax:530-242-8544
Practice Address - Street 1:1555 EAST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-242-4683
Practice Address - Fax:530-242-8544
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48373174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110233370OtherMEDICARE RAILROAD
CAA48373OtherMEDICAL LICENSE
CAGR0070840Medicaid
CAGR0070840Medicaid
CAA48373OtherMEDICAL LICENSE
CA110233370OtherMEDICARE RAILROAD