Provider Demographics
NPI:1205152113
Name:PATEL, MONTU JAGDISH (MD)
Entity type:Individual
Prefix:DR
First Name:MONTU
Middle Name:JAGDISH
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 1:800 N OKLAHOMA AVE APT 1442
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4418
Mailing Address - Country:US
Mailing Address - Phone:504-957-8629
Mailing Address - Fax:
Practice Address - Street 1:OU MEDICAL CENTER
Practice Address - Street 2:700 NE 13TH ST
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10036772207R00000X
LAMD.2049422085R0202X
IL036.1364322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine