Provider Demographics
NPI:1457526832
Name:PATIL, RAJU AMAREGOUDA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RAJU
Middle Name:AMAREGOUDA
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 WINDSOR PL STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1866
Mailing Address - Country:US
Mailing Address - Phone:682-207-1700
Mailing Address - Fax:682-250-5246
Practice Address - Street 1:1902 WINDSOR PL STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1866
Practice Address - Country:US
Practice Address - Phone:682-207-1700
Practice Address - Fax:682-250-5246
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6256207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX396787901Medicaid
TX1457526832Medicaid