Provider Demographics
NPI:1891836920
Name:PATEL, MITUL KANTI (MD)
Entity Type:Individual
Prefix:DR
First Name:MITUL
Middle Name:KANTI
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-0200
Practice Address - Fax:615-885-0267
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000037381174400000X
TN37381207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64063795Medicaid
9303776OtherCIGNA
TN4343269OtherBCBS TN
5473141OtherFIRST HEALTH
201221325OtherUNITED HEALTHCARE
TN3884156Medicaid
TNQ000660Medicaid
201221325OtherHEALTHSPRING
201221325OtherTRICARE
7587475OtherAETNA
201221325OtherGREAT WEST HEALTHCARE
TN4091543OtherBLUECROSS
201221325OtherTRICARE
201221325OtherUNITED HEALTHCARE
201221325OtherTRICARE
TN3884156Medicare ID - Type Unspecified