Provider Demographics
NPI:1649925199
Name:PATEL, KIRAN
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ARNET ST STE 130
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5735
Mailing Address - Country:US
Mailing Address - Phone:734-483-4313
Mailing Address - Fax:734-483-1305
Practice Address - Street 1:200 ARNET ST STE 130
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5735
Practice Address - Country:US
Practice Address - Phone:734-483-4313
Practice Address - Fax:734-483-1305
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302027188Medicaid
MI5315104506Medicaid