Provider Demographics
NPI:1629723481
Name:PATEL, VIBHUTI (RD)
Entity Type:Individual
Prefix:
First Name:VIBHUTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 STOUT ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3113
Mailing Address - Country:US
Mailing Address - Phone:517-420-6545
Mailing Address - Fax:
Practice Address - Street 1:30700 TELEGRAPH RD STE 1540
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5811
Practice Address - Country:US
Practice Address - Phone:720-205-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12748923-4901133V00000X
WADI61326700133V00000X
OR10225566133V00000X
IL164008847133V00000X
MI951532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered