Provider Demographics
NPI:1013917236
Name:PATEL, SUDHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:49848 COOKE AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2885
Mailing Address - Country:US
Mailing Address - Phone:734-459-4128
Mailing Address - Fax:734-728-1400
Practice Address - Street 1:34210 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5439
Practice Address - Country:US
Practice Address - Phone:734-728-2300
Practice Address - Fax:734-728-1400
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MISP042387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1874675Medicaid
MIA73624Medicare UPIN
MI0820800Medicare ID - Type Unspecified