Provider Demographics
NPI:1609396506
Name:PATEL, PRIYA P (DPM)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:N49W15485 ORCHID CT
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2252
Mailing Address - Country:US
Mailing Address - Phone:847-638-3435
Mailing Address - Fax:
Practice Address - Street 1:N49W15485 ORCHID CT
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2252
Practice Address - Country:US
Practice Address - Phone:847-638-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001345A213ES0103X
IL135.000962213ES0103X
WI1205-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery