Provider Demographics
NPI:1881655066
Name:PATEL, BIPINCHANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BIPINCHANDRA
Middle Name:M
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 1:111 CLYDE ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1566
Mailing Address - Country:US
Mailing Address - Phone:865-458-1554
Mailing Address - Fax:865-458-1762
Practice Address - Street 1:111 CLYDE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1566
Practice Address - Country:US
Practice Address - Phone:865-458-1554
Practice Address - Fax:865-458-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3074152Medicaid
TN3074152Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER