Provider Demographics
NPI:1710141668
Name:PATEL, NIMISH KANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMISH
Middle Name:KANTILAL
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 1:1040 EDGEWATER CORP PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-4514
Mailing Address - Country:US
Mailing Address - Phone:803-548-7007
Mailing Address - Fax:
Practice Address - Street 1:1040 EDGEWATER CORPORATE PKWY SUITE 101
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7177
Practice Address - Country:US
Practice Address - Phone:803-548-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32108207Q00000X
NC2008-01850207Q00000X
NJ25MA08503500207Q00000X
MI4301091628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty