Provider Demographics
NPI:1396951448
Name:PATEL-CHAMBERLIN, MUKTI (MD)
Entity type:Individual
Prefix:
First Name:MUKTI
Middle Name:
Last Name:PATEL-CHAMBERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:PATEL-CHAMBERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4600 MONTGOMERY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2697
Mailing Address - Country:US
Mailing Address - Phone:513-548-7530
Mailing Address - Fax:513-487-5317
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:STE 404
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-5630
Practice Address - Fax:513-241-7146
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097342207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050860Medicaid
H011490Medicare PIN
H011491Medicare PIN
OHH011494Medicare PIN