Provider Demographics
NPI:1013304088
Name:PATEL, MAULIKKUMAR ARVINDBHAI (MD)
Entity Type:Individual
Prefix:
First Name:MAULIKKUMAR
Middle Name:ARVINDBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-6141
Mailing Address - Country:US
Mailing Address - Phone:478-621-2072
Mailing Address - Fax:678-540-8623
Practice Address - Street 1:1005 BOULDER DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-6141
Practice Address - Country:US
Practice Address - Phone:478-874-8368
Practice Address - Fax:678-540-8623
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83263207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine