Provider Demographics
NPI:1932143971
Name:PATEL, BHUPENDRANATH GALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BHUPENDRANATH
Middle Name:GALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6770 DIXIE HWY STE 303
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2090
Mailing Address - Country:US
Mailing Address - Phone:248-625-0030
Mailing Address - Fax:
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-625-0030
Practice Address - Fax:248-625-4403
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932143971Medicaid
MION37480Medicare ID - Type Unspecified