Provider Demographics
NPI:1639120660
Name:PATEL, VINA R (MD)
Entity Type:Individual
Prefix:
First Name:VINA
Middle Name:R
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 1:5205 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3027
Mailing Address - Country:US
Mailing Address - Phone:810-733-0400
Mailing Address - Fax:810-733-8638
Practice Address - Street 1:5205 NORKO DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3027
Practice Address - Country:US
Practice Address - Phone:810-733-0400
Practice Address - Fax:810-733-8638
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP59531OtherBCN
MI1007181OtherMCLAREN HEALTH PLAN
MI4821236Medicaid
MI14695OtherMCARE