Provider Demographics
NPI:1629030788
Name:PATEL, LATIKA DUSHYANT (MD)
Entity Type:Individual
Prefix:DR
First Name:LATIKA
Middle Name:DUSHYANT
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 1:1424 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5160
Mailing Address - Country:US
Mailing Address - Phone:704-289-2944
Mailing Address - Fax:704-283-2918
Practice Address - Street 1:1424 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5160
Practice Address - Country:US
Practice Address - Phone:704-289-2944
Practice Address - Fax:704-283-2918
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561759007Medicaid