Provider Demographics
NPI:1639106198
Name:PATEL, MUKESHCHANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESHCHANDRA
Middle Name:M
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:P O BOX 1030
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1030
Mailing Address - Country:US
Mailing Address - Phone:760-946-1344
Mailing Address - Fax:760-946-2477
Practice Address - Street 1:16018 TUSCOLA RD 9
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1329
Practice Address - Country:US
Practice Address - Phone:760-946-1344
Practice Address - Fax:760-946-2477
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43158Medicaid
CAE35205Medicare UPIN
CAA43158Medicaid