Provider Demographics
NPI:1740403765
Name:PATEL, CHIRAG B (MD)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:B
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:407 N MEADOW ST
Practice Address - Street 2:
Practice Address - City:OTTERBEIN
Practice Address - State:IN
Practice Address - Zip Code:47970-8592
Practice Address - Country:US
Practice Address - Phone:765-583-4415
Practice Address - Fax:765-583-2444
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013064A207Q00000X
IN01066732A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001016224OtherURGENT CARE ANTHEM PIN FOR TIN 352030653
IN200285920Medicaid
IN000000622154OtherANTHEM PROVIDER NUMBER
IN815500Z3Medicare PIN
IN200285920Medicaid