Provider Demographics
NPI:1710110457
Name:PATEL, AMBRISH M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AMBRISH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:970-490-4175
Practice Address - Street 1:5050 POWDERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4800
Practice Address - Country:US
Practice Address - Phone:307-634-1311
Practice Address - Fax:307-634-1271
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2015-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06310363AM0700X
WYPT605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW26267Medicare PIN