Provider Demographics
NPI: | 1023061868 |
---|---|
Name: | PATEL, MIHIR M (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | MIHIR |
Middle Name: | M |
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: | 8450 NORTHWEST BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46278-1381 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-802-2000 |
Mailing Address - Fax: | 317-802-2170 |
Practice Address - Street 1: | 8450 NORTHWEST BLVD. |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46278-1381 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-802-2000 |
Practice Address - Fax: | 317-802-2170 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-19 |
Last Update Date: | 2024-05-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01058888 | 207X00000X |
IN | 01058888A | 207XX0004X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 200204320 | Medicaid | |
IN | 200204320 | Medicaid | |
IN | 200204320 | Medicaid |