Provider Demographics
NPI:1861478554
Name:PATEL, PARIMAL B (MD)
Entity Type:Individual
Prefix:
First Name:PARIMAL
Middle Name:B
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 78219
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-8219
Mailing Address - Country:US
Mailing Address - Phone:314-344-7770
Mailing Address - Fax:314-298-0556
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:SUITE 490
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-344-7770
Practice Address - Fax:314-298-0556
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001653662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205077126Medicaid
MO950244203Medicare PIN
MOH04269Medicare UPIN