Provider Demographics
NPI:1700813136
Name:PATEL, MUKESH R (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 CLEAR LAKE CITY BLVD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5500
Mailing Address - Country:US
Mailing Address - Phone:281-464-8988
Mailing Address - Fax:281-464-7744
Practice Address - Street 1:780 CLEAR LAKE CITY BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5500
Practice Address - Country:US
Practice Address - Phone:281-464-8988
Practice Address - Fax:281-464-7744
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159387301Medicaid
TX8A6200Medicare PIN
TX159387301Medicaid