Provider Demographics
NPI:1922182369
Name:K M PATEL MD INC & ASSOC
Entity Type:Organization
Organization Name:K M PATEL MD INC & ASSOC
Other - Org Name:KANAIYALAL M PATEL MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KANAIYALAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-473-0525
Mailing Address - Street 1:6817 WILDWOOD TRAIL
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-473-0525
Mailing Address - Fax:440-473-0525
Practice Address - Street 1:44 BLAINE ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146
Practice Address - Country:US
Practice Address - Phone:440-735-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041383P207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH125462490OtherWORKERS COMPENSATION
OH000000165529OtherANTHEM
OH0498831Medicaid
OH000000165529OtherANTHEM
OH125462490OtherWORKERS COMPENSATION