Provider Demographics
NPI:1699185249
Name:PATEL, KUNJ G (MD)
Entity Type:Individual
Prefix:
First Name:KUNJ
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3909 CASTELLINA WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8454
Mailing Address - Country:US
Mailing Address - Phone:314-282-7246
Mailing Address - Fax:301-579-4284
Practice Address - Street 1:4455 DUNCAN AVE STE 8N
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1111
Practice Address - Country:US
Practice Address - Phone:314-282-7246
Practice Address - Fax:301-579-4284
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274535207L00000X
IL036.150024208100000X, 208D00000X, 208VP0000X
MO2019016517208D00000X, 208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine