Provider Demographics
NPI:1760624951
Name:PATEL, DIPSU DILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPSU
Middle Name:DILIP
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:PO BOX 890089
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0089
Mailing Address - Country:US
Mailing Address - Phone:409-945-5444
Mailing Address - Fax:409-945-4133
Practice Address - Street 1:6807 EMMETT F LOWRY EXPY STE 108
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2547
Practice Address - Country:US
Practice Address - Phone:409-945-5444
Practice Address - Fax:409-945-4133
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2742207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI19127Medicare UPIN
TXTXB106525Medicare PIN