Provider Demographics
NPI:1013965128
Name:PATEL, ASHOK R (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:R
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 1:540 E ABRIENDO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2377
Mailing Address - Country:US
Mailing Address - Phone:719-542-7222
Mailing Address - Fax:
Practice Address - Street 1:540 E ABRIENDO AVE STE D
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2377
Practice Address - Country:US
Practice Address - Phone:719-542-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223371207K00000X
CO27185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021119Medicaid
CO04021119Medicaid
COE73735Medicare UPIN