Provider Demographics
NPI:1780947531
Name:PATEL, NISHANT ANILKUMAR (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:NISHANT
Middle Name:ANILKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO601302085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201197940AMedicaid
CO9000159664Medicaid
NENA1215135OtherMEDICARE PTAN
NENA2517111OtherMEDICARE PTAN
KS111257118OtherMEDICARE PTAN
NENA1214134OtherMEDICARE PTAN
KSKA3249109OtherMEDICARE PTAN
NE$$$$$$$$$04Medicaid
NE$$$$$$$$$05Medicaid
NE$$$$$$$$$03Medicaid
NE$$$$$$$$$08Medicaid
NE$$$$$$$$$07Medicaid
NENA1215135OtherMEDICARE PTAN
NE$$$$$$$$$00Medicaid
NE$$$$$$$$$01Medicaid
NE$$$$$$$$$02Medicaid