Provider Demographics
NPI:1578517421
Name:PATEL, RAJENDRAKUMAR I (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRAKUMAR
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:I
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1206 W FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-3206
Mailing Address - Country:US
Mailing Address - Phone:417-673-2448
Mailing Address - Fax:417-673-8374
Practice Address - Street 1:1206 W FOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-3206
Practice Address - Country:US
Practice Address - Phone:417-673-2448
Practice Address - Fax:417-673-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201055027Medicaid
MO201055027Medicaid
MOB18503Medicare UPIN