Provider Demographics
NPI:1669428074
Name:PATEL, SHILPESH SHANTILAL (MD)
Entity type:Individual
Prefix:
First Name:SHILPESH
Middle Name:SHANTILAL
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:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29716-1089
Mailing Address - Country:US
Mailing Address - Phone:803-835-6500
Mailing Address - Fax:803-835-1990
Practice Address - Street 1:515 RIVER CROSSING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7900
Practice Address - Country:US
Practice Address - Phone:803-835-6500
Practice Address - Fax:803-835-1990
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200838Medicaid
SCF67746Medicare UPIN