Provider Demographics
NPI:1356755813
Name:ALLEN COUNTY INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:ALLEN COUNTY INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-714-0220
Mailing Address - Street 1:12515 GOLDEN HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9031
Mailing Address - Country:US
Mailing Address - Phone:217-714-0220
Mailing Address - Fax:
Practice Address - Street 1:12515 GOLDEN HARVEST DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9031
Practice Address - Country:US
Practice Address - Phone:217-714-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201240270 BMedicaid
IN201240270 CMedicaid
IN201240270 DMedicaid
IN201240270 AMedicaid
IN201240270 EMedicaid
ININ2044Medicare PIN