Provider Demographics
NPI:1629216841
Name:PATEL, AJAY ARVIND (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:ARVIND
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 1:3092 SCHOOLHOUSE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3472
Practice Address - Country:US
Practice Address - Phone:586-573-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119196207P00000X
MI4301093985207P00000X
TXN6566207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629216841OtherTRI CARE SOUTH
TX8CK893OtherBCBS TX
TX1629216841OtherBCBS TX
TX214951002Medicaid
TX214951003Medicaid
TXP00975219OtherRAILROAD
TXTXB131631Medicare PIN
TXTXB131630Medicare PIN
TXP00975219OtherRAILROAD