Provider Demographics
NPI:1790160323
Name:KUNAL K. PATRA, M.D., P.C.
Entity Type:Organization
Organization Name:KUNAL K. PATRA, M.D., P.C.
Other - Org Name:ONE PSYCHIATRY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-574-9936
Mailing Address - Street 1:410 BAYHILL CIR
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5092
Mailing Address - Country:US
Mailing Address - Phone:605-232-2082
Mailing Address - Fax:
Practice Address - Street 1:211 SIOUX POINT ROAD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5092
Practice Address - Country:US
Practice Address - Phone:712-574-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD90892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366402505Medicare UPIN