Provider Demographics
NPI:1578672622
Name:PATEL, SHANTILAL S (MD)
Entity Type:Individual
Prefix:
First Name:SHANTILAL
Middle Name:S
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3175
Mailing Address - Fax:812-242-3543
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3175
Practice Address - Fax:812-242-3543
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032912A207RC0000X
IL36065647207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089599OtherANTHEM
060002293OtherRAILROAD MCARE PALAMETTO
IN100251290Medicaid
IN110044264OtherRAILROAD MEDICARE
INP00209796OtherRAILROAD MEDICARE
INP00844278OtherRAILROAD MEDICARE
C25914Medicare UPIN
IN859910ZMedicare PIN
INP00209796OtherRAILROAD MEDICARE
INP00844278OtherRAILROAD MEDICARE
IN265130GMedicare PIN
000000089599OtherANTHEM
IN100251290Medicaid