Provider Demographics
NPI:1962864579
Name:PATEL, MIHIR
Entity Type:Individual
Prefix:
First Name:MIHIR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 KIRTS BLVD
Mailing Address - Street 2:APT # 209
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1440 KIRTS BLVD
Practice Address - Street 2:APT # 209
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4350
Practice Address - Country:US
Practice Address - Phone:248-952-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MI5501015051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015051OtherSTATE