Provider Demographics
NPI:1922464171
Name:MAHENDRA M PATEL MD PSC
Entity Type:Organization
Organization Name:MAHENDRA M PATEL MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-982-5112
Mailing Address - Street 1:912 WOODLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2795
Mailing Address - Country:US
Mailing Address - Phone:270-982-5112
Mailing Address - Fax:270-982-5111
Practice Address - Street 1:912 WOODLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2795
Practice Address - Country:US
Practice Address - Phone:270-982-5112
Practice Address - Fax:270-982-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY178718207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-178718Medicaid
KY1052298OtherPASSPORT
KY64-178718Medicaid
KY1170101Medicare PIN