Provider Demographics
NPI:1881181154
Name:PATEL, HEMANTKUMAR KHUSHALDAS
Entity Type:Individual
Prefix:MR
First Name:HEMANTKUMAR
Middle Name:KHUSHALDAS
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 RIVERWIND DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9369
Mailing Address - Country:US
Mailing Address - Phone:614-302-0054
Mailing Address - Fax:
Practice Address - Street 1:344 RIVERWIND DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9369
Practice Address - Country:US
Practice Address - Phone:614-302-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-22
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17-568246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant