Provider Demographics
NPI:1578768131
Name:PATEL, KUNAL MANOHAR
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:MANOHAR
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 1:333 N COMMERCIAL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2657
Mailing Address - Country:US
Mailing Address - Phone:614-722-2350
Mailing Address - Fax:614-722-2332
Practice Address - Street 1:333 N COMMERCIAL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2657
Practice Address - Country:US
Practice Address - Phone:920-886-7525
Practice Address - Fax:920-722-7454
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090426390200000X
MN390200000X
WI60302-202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program