Provider Demographics
NPI:1013954221
Name:PATEL, TARAK J (MD)
Entity Type:Individual
Prefix:
First Name:TARAK
Middle Name:J
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 1:4114 POND HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1273
Mailing Address - Country:US
Mailing Address - Phone:210-249-5020
Mailing Address - Fax:210-572-1540
Practice Address - Street 1:4114 POND HILL ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-249-5020
Practice Address - Fax:210-494-2209
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5652208000000X, 2080S0012X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21480OtherMEDICARE- SAN ANTONIO
TX8F22537OtherMEDICARE- HOUSTON
TX047712707OtherMEDICAID - HOUSTON
TX047712706OtherMEDICAID - SAN ANTONIO