Provider Demographics
NPI:1972832962
Name:PATEL, MIRAL
Entity Type:Individual
Prefix:
First Name:MIRAL
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 1:99 DOCTORS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058-6303
Mailing Address - Country:US
Mailing Address - Phone:901-840-1998
Mailing Address - Fax:
Practice Address - Street 1:99 DOCTORS DR STE 100
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-6303
Practice Address - Country:US
Practice Address - Phone:901-840-1998
Practice Address - Fax:901-840-1975
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6682850001Medicare NSC