Provider Demographics
NPI:1588604573
Name:PATEL, RAJIV N (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:N
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 1:500 KIRTS BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4134
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:500 KIRTS BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4134
Practice Address - Country:US
Practice Address - Phone:248-824-6600
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019698207R00000X
MI4301500426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO923730166Medicare ID - Type UnspecifiedSMHC-MO
MO923731373Medicare PIN
MO923735164Medicare PIN