Provider Demographics
NPI:1710563028
Name:KISHOR PATEL MD LLC
Entity Type:Organization
Organization Name:KISHOR PATEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-262-2050
Mailing Address - Street 1:21851 CENTER RIDGE RD
Mailing Address - Street 2:405
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3976
Mailing Address - Country:US
Mailing Address - Phone:440-333-5822
Mailing Address - Fax:440-333-5824
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:405
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-333-5822
Practice Address - Fax:440-333-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0814855Medicaid