Provider Demographics
NPI:1629002076
Name:PATEL, MANISHA AMI (MD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:AMI
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 E GALBRAITH RD STE 215
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6706
Mailing Address - Country:US
Mailing Address - Phone:513-421-3494
Mailing Address - Fax:513-345-2606
Practice Address - Street 1:4750 E GALBRAITH RD STE 215
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6706
Practice Address - Country:US
Practice Address - Phone:513-421-3494
Practice Address - Fax:513-345-2606
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37777208600000X, 208G00000X
OH35081783P208600000X, 208G00000X
VT042-0017034208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
310804060036OtherCARESOURCE
OH2351280Medicaid
KY64107634Medicaid
000000245368OtherANTHEM
1800452OtherUNITED HEALTHCARE
81783OtherCHOICE CARE/HUMANA
8330OtherKY BCBS
330005925Medicare PIN
000000245368OtherANTHEM
310804060036OtherCARESOURCE
81783OtherCHOICE CARE/HUMANA
KY0677809Medicare ID - Type UnspecifiedKY MEDICARE
OH4093061Medicare PIN