Provider Demographics
NPI:1295703866
Name:PATEL, VIJAYKUMAR N (MD)
Entity type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:N
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 1:30900 FORD RD STE B
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1892
Mailing Address - Country:US
Mailing Address - Phone:734-524-0920
Mailing Address - Fax:734-524-0921
Practice Address - Street 1:30900 FORD RD STE B
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1892
Practice Address - Country:US
Practice Address - Phone:734-524-0920
Practice Address - Fax:734-524-0921
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59998Medicare UPIN