Provider Demographics
NPI:1457420622
Name:PATEL, SHIRISH C (MD)
Entity Type:Individual
Prefix:
First Name:SHIRISH
Middle Name:C
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 1:1027 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4154
Mailing Address - Country:US
Mailing Address - Phone:626-570-8889
Mailing Address - Fax:626-570-0036
Practice Address - Street 1:1027 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4154
Practice Address - Country:US
Practice Address - Phone:626-570-8889
Practice Address - Fax:626-570-0036
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30379208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD8738OtherRAILROAD MEDICARE
CAA30379OtherLICENSE
CABH026ZMedicare PIN
A26095Medicare UPIN