Provider Demographics
NPI:1891776530
Name:PATEL, KUNTHAVAI S (MD)
Entity Type:Individual
Prefix:MRS
First Name:KUNTHAVAI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851
Mailing Address - Country:US
Mailing Address - Phone:662-456-3437
Mailing Address - Fax:662-456-2070
Practice Address - Street 1:208 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851
Practice Address - Country:US
Practice Address - Phone:662-456-3437
Practice Address - Fax:662-456-2070
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS13688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112962Medicaid
MSF71098Medicare UPIN
MS00112962Medicaid