Provider Demographics
NPI:1659354868
Name:PATEL, RAHUL LALITCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:LALITCHANDRA
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:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-0191
Mailing Address - Country:US
Mailing Address - Phone:209-825-1660
Mailing Address - Fax:209-825-1470
Practice Address - Street 1:1148 NORMAN DR
Practice Address - Street 2:STE 4
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5961
Practice Address - Country:US
Practice Address - Phone:209-825-1660
Practice Address - Fax:209-825-1470
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 50086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 500860Medicaid
CAA 500860Medicare ID - Type Unspecified
CAF 07664Medicare UPIN