Provider Demographics
NPI:1760469217
Name:PATEL, KEYUR N (DO)
Entity Type:Individual
Prefix:
First Name:KEYUR
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE A440
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-4172
Mailing Address - Fax:859-313-3541
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A440
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-4172
Practice Address - Fax:859-313-3541
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64017619Medicaid
KY0654804Medicare ID - Type Unspecified
KY0758305Medicare ID - Type Unspecified
KY0614704Medicare ID - Type Unspecified
KY64017619Medicaid
H19628Medicare UPIN