Provider Demographics
NPI:1134154545
Name:PATEL, CHANDRAKANT G (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRAKANT
Middle Name:G
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 1:1411 S HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7842
Mailing Address - Country:US
Mailing Address - Phone:409-722-3175
Mailing Address - Fax:409-727-7987
Practice Address - Street 1:1411 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7842
Practice Address - Country:US
Practice Address - Phone:409-722-3175
Practice Address - Fax:409-727-7987
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3872207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042QUOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX115272001Medicaid
TX4501009353OtherCLIA
TX8AU520OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX8AU520OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX115272001Medicaid
TX00Y963Medicare PIN