Provider Demographics
NPI:1902826936
Name:PATEL, VIKRAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
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:P.O. BOX 945
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-0945
Mailing Address - Country:US
Mailing Address - Phone:317-887-1333
Mailing Address - Fax:317-887-5731
Practice Address - Street 1:898 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1407
Practice Address - Country:US
Practice Address - Phone:317-887-1333
Practice Address - Fax:317-887-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010315012084P0800X
IN01031501A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100260740Medicaid
IN100260740AMedicaid
IN100260740AMedicaid
M400037444Medicare PIN
IN100260740Medicaid
INC25402Medicare UPIN