Provider Demographics
NPI:1881687101
Name:PATEL, MADHUSUDAN F (MD)
Entity Type:Individual
Prefix:
First Name:MADHUSUDAN
Middle Name:F
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 1:723 PHILLIPS AVE
Mailing Address - Street 2:SUITE 201-A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1300
Mailing Address - Country:US
Mailing Address - Phone:419-476-2124
Mailing Address - Fax:419-476-3882
Practice Address - Street 1:723 PHILLIPS AVE
Practice Address - Street 2:SUITE 201-A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1300
Practice Address - Country:US
Practice Address - Phone:419-476-2124
Practice Address - Fax:419-476-3882
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0098P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-05-0098POtherLICENSE
OH35-05-0098POtherLICENSE