Provider Demographics
NPI:1720151038
Name:PATEL, HARESH DESAIBHAI (MD)
Entity Type:Individual
Prefix:
First Name:HARESH
Middle Name:DESAIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARESHKUMAR
Other - Middle Name:D
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC918212207L00000X
TNMD18595207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0156001OtherBLUE CROSS BLUE SHIELD TN
NC890692VMedicaid
AL009204170Medicaid
TN050043300OtherMEDICARE RAILROAD
TN1513508Medicaid
GAN346387OtherWELLCARE (GA MEDICAID)
GA000503621AMedicaid
TN0156001OtherBLUE CROSS BLUE SHIELD TN
GAN346387OtherWELLCARE (GA MEDICAID)