Provider Demographics
NPI:1578522793
Name:PATEL, JAGDISH R (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:R
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 1:1941 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331
Mailing Address - Country:US
Mailing Address - Phone:765-827-7795
Mailing Address - Fax:765-827-7796
Practice Address - Street 1:2025 VIRGINIA AVE STE C
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2921
Practice Address - Country:US
Practice Address - Phone:765-827-0876
Practice Address - Fax:765-825-6999
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000824A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000080791OtherBLUE CROSS
IN100114680Medicaid
IN100114680Medicaid
IN231420UMedicare ID - Type Unspecified