Provider Demographics
NPI:1922036912
Name:PATEL, NIRMAL B (MD)
Entity Type:Individual
Prefix:
First Name:NIRMAL
Middle Name:B
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 1:22505 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2237
Mailing Address - Country:US
Mailing Address - Phone:734-671-6217
Mailing Address - Fax:734-671-2888
Practice Address - Street 1:302 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MI
Practice Address - Zip Code:48615-9579
Practice Address - Country:US
Practice Address - Phone:989-842-3118
Practice Address - Fax:989-842-1110
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01004494OtherHEALTHPLUS COMMERCIAL
MI0802911742OtherBCBSM
MI200000006108OtherPHP COMMERCIAL
MI1021014OtherMCLAREN HEALTH PLAN
MI4890888-10Medicaid
MI4890888-10Medicaid
MI238521Medicare Oscar/Certification
MIM17400014Medicare PIN