Provider Demographics
NPI:1598755530
Name:PATEL, KIRTIKUMAR L (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRTIKUMAR
Middle Name:L
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:407 S MEDICAL ARTS CT STE D
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3372
Mailing Address - Country:US
Mailing Address - Phone:307-682-0400
Mailing Address - Fax:307-686-7420
Practice Address - Street 1:407 S MEDICAL ARTS CT STE D
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3372
Practice Address - Country:US
Practice Address - Phone:307-682-0400
Practice Address - Fax:307-686-7420
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5004A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY102584800Medicaid
WYW307666Medicare PIN
E66221Medicare UPIN