Provider Demographics
NPI:1841613437
Name:PATEL, KISHOR VALAJIBHAI (PA-C)
Entity Type:Individual
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First Name:KISHOR
Middle Name:VALAJIBHAI
Last Name:PATEL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9789 CHARLOTTE HWY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7177
Mailing Address - Country:US
Mailing Address - Phone:803-548-7007
Mailing Address - Fax:803-802-2015
Practice Address - Street 1:9789 CHARLOTTE HWY
Practice Address - Street 2:SUITE 1400
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7177
Practice Address - Country:US
Practice Address - Phone:803-548-7007
Practice Address - Fax:803-802-2015
Is Sole Proprietor?:No
Enumeration Date:2014-02-02
Last Update Date:2014-04-06
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Provider Licenses
StateLicense IDTaxonomies
SC2048363A00000X
NC0010-04710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant