Provider Demographics
NPI:1265643852
Name:PATEL, ANITA DHIRUBHAI (DO)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:DHIRUBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746079
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6079
Mailing Address - Country:US
Mailing Address - Phone:127-339-7303
Mailing Address - Fax:
Practice Address - Street 1:1213 E TRINITY MILLS RD STE 173
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1446
Practice Address - Country:US
Practice Address - Phone:972-962-1296
Practice Address - Fax:469-340-4129
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3916208000000X, 207R00000X
TXM8238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI28616Medicare UPIN
OK1203916Medicare ID - Type Unspecified