Provider Demographics
NPI:1649401191
Name:ANIL PATEL MEDICAL REHABILITATION PC
Entity Type:Organization
Organization Name:ANIL PATEL MEDICAL REHABILITATION PC
Other - Org Name:LAKE MEAD MEDICAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-255-3003
Mailing Address - Street 1:8576 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7630
Mailing Address - Country:US
Mailing Address - Phone:702-255-3003
Mailing Address - Fax:702-255-8133
Practice Address - Street 1:8576 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7630
Practice Address - Country:US
Practice Address - Phone:702-255-3003
Practice Address - Fax:702-255-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6316110001Medicare NSC