Provider Demographics
NPI:1588672943
Name:PATEL, VIKRAM N (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
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:PO BOX 4756
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704
Mailing Address - Country:US
Mailing Address - Phone:432-686-7474
Mailing Address - Fax:432-686-7524
Practice Address - Street 1:2407 W LOUISIANA STE 104
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-686-7474
Practice Address - Fax:432-686-7524
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2008207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178556001Medicaid
TX178557801Medicaid
TXP00298875OtherRAIL ROAD MEDICARE
8F2310Medicare ID - Type Unspecified
TXP00298875OtherRAIL ROAD MEDICARE
TX178556001Medicaid