Provider Demographics
NPI:1740388396
Name:PATEL, NIKUNJKUMAR I (MD)
Entity Type:Individual
Prefix:
First Name:NIKUNJKUMAR
Middle Name:I
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 1:367 S GULPH RD
Mailing Address - Street 2:ATN :IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:580-297-5166
Mailing Address - Fax:580-237-1340
Practice Address - Street 1:310 E OWEN K GARRIOTT ROAD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5712
Practice Address - Country:US
Practice Address - Phone:580-297-5166
Practice Address - Fax:580-237-1340
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7099207RC0000X, 207RI0011X
OK38037207RI0011X
ORCP203988207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1P9634OtherPTAN
OK200982470AMedicaid
80676SOtherBCBS
TX162981801Medicaid
P00068036OtherRAILROAD MEDICARE
101976100OtherFIRSTCARE
TX162981801Medicaid
TXP00068036Medicare PIN