Provider Demographics
NPI:1942448212
Name:ANOOPA PATEL LLC
Entity Type:Organization
Organization Name:ANOOPA PATEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-293-5352
Mailing Address - Street 1:PO BOX 292410
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0410
Mailing Address - Country:US
Mailing Address - Phone:937-293-5352
Mailing Address - Fax:937-293-5566
Practice Address - Street 1:207 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2825
Practice Address - Country:US
Practice Address - Phone:937-293-5352
Practice Address - Fax:937-293-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079223P173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2303608Medicaid
4055933Medicare PIN
OH2303608Medicaid