Provider Demographics
NPI:1770687204
Name:NILESH PATEL MD PC
Entity Type:Organization
Organization Name:NILESH PATEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-277-6700
Mailing Address - Street 1:21031 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2339
Mailing Address - Country:US
Mailing Address - Phone:313-277-6700
Mailing Address - Fax:313-216-0176
Practice Address - Street 1:21031 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-277-3585
Practice Address - Fax:313-277-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207XS0117X
MI=========207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII10802Medicare UPIN
MI5998760001Medicare NSC