Provider Demographics
NPI:1245488188
Name:PATEL, SUDHA MOGALI (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:MOGALI
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:205 WEST US 60
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146
Mailing Address - Country:US
Mailing Address - Phone:270-547-7161
Mailing Address - Fax:270-547-7163
Practice Address - Street 1:205 WEST US 60
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:KY
Practice Address - Zip Code:40146
Practice Address - Country:US
Practice Address - Phone:270-547-7161
Practice Address - Fax:270-547-7163
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-472992084P0800X
KY448692084P0800X
MO20080156422084P0800X
IN01073852A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK043270Medicare PIN