Provider Demographics
NPI:1790773729
Name:PATEL, SUMAN (MD)
Entity Type:Individual
Prefix:
First Name:SUMAN
Middle Name:
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 1:2901 S NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1001
Mailing Address - Country:US
Mailing Address - Phone:734-729-7220
Mailing Address - Fax:734-729-7227
Practice Address - Street 1:2901 S NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1001
Practice Address - Country:US
Practice Address - Phone:734-729-7220
Practice Address - Fax:734-729-7227
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP406326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4192463Medicaid
MI2860306Medicaid
MI4192463Medicaid
P07870Medicare ID - Type Unspecified