Provider Demographics
NPI:1689021636
Name:PATEL, VIRAL MANUBHAI (OD)
Entity Type:Individual
Prefix:
First Name:VIRAL
Middle Name:MANUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 EASTROCK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-1737
Mailing Address - Country:US
Mailing Address - Phone:815-226-1500
Mailing Address - Fax:815-484-9307
Practice Address - Street 1:2995 EASTROCK DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-1737
Practice Address - Country:US
Practice Address - Phone:815-226-1500
Practice Address - Fax:815-484-9307
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program