Provider Demographics
NPI:1700985454
Name:PATEL, DIPESH RATILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPESH
Middle Name:RATILAL
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 1:3780 EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-0800
Mailing Address - Country:US
Mailing Address - Phone:478-633-5550
Mailing Address - Fax:478-784-5496
Practice Address - Street 1:3780 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0800
Practice Address - Country:US
Practice Address - Phone:478-633-5550
Practice Address - Fax:478-784-5496
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00238817OtherRAILROAD MEDICARE
GA493006848AMedicaid
08BBRSFMedicare ID - Type Unspecified
126088Medicare UPIN
GA493006848AMedicaid