Provider Demographics
NPI:1902866619
Name:PATIL, SANDESH R (MD)
Entity Type:Individual
Prefix:
First Name:SANDESH
Middle Name:R
Last Name:PATIL
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 1:214 HOSPITAL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7627
Mailing Address - Country:US
Mailing Address - Phone:606-633-6255
Mailing Address - Fax:606-633-6236
Practice Address - Street 1:214 HOSPITAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7627
Practice Address - Country:US
Practice Address - Phone:606-633-6255
Practice Address - Fax:606-633-6236
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36248207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000510294OtherHEART CENTER LLC -BCBS OF KY PIN #
KY64017890Medicaid
VA010016151Medicaid
KY000000584948OtherBCBS- CUMBERLAND CLINIC
KY000000178786OtherBCBS OF KY
KY64017890Medicaid
F88231Medicare UPIN
KY0305818Medicare PIN
KY00190003Medicare PIN
KY060060651Medicare PIN