Provider Demographics
NPI:1124792551
Name:PATEL, KAJAL B (APRN)
Entity type:Individual
Prefix:
First Name:KAJAL
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6107 S DUNE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-6421
Mailing Address - Country:US
Mailing Address - Phone:847-414-1605
Mailing Address - Fax:
Practice Address - Street 1:3156 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4424
Practice Address - Country:US
Practice Address - Phone:219-762-9444
Practice Address - Fax:219-762-2288
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71011350A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health