Provider Demographics
NPI:1629392543
Name:PATEL, UTKARSH JAYANTILAL (RPT)
Entity Type:Individual
Prefix:MR
First Name:UTKARSH
Middle Name:JAYANTILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:989-772-7755
Mailing Address - Fax:989-772-7750
Practice Address - Street 1:669 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-2215
Practice Address - Country:US
Practice Address - Phone:989-772-7755
Practice Address - Fax:989-772-7750
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501014919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014919OtherSTATE OF MICHIGAN