Provider Demographics
NPI:1649493123
Name:PATEL, TEJESH (MBBS, MD)
Entity type:Individual
Prefix:DR
First Name:TEJESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 CRESTHAVEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 MADISON AVE STE 890
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3413
Practice Address - Country:US
Practice Address - Phone:901-866-8834
Practice Address - Fax:901-302-2834
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48564207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181385AMedicaid
MS07724809Medicaid
AR196470001Medicaid
MO1649493123Medicaid
TN1530732Medicaid