Provider Demographics
NPI:1811047020
Name:PATEL, ANILKUMAR AMBALAL (CERTIFIED SURGICAL A)
Entity type:Individual
Prefix:
First Name:ANILKUMAR
Middle Name:AMBALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:CERTIFIED SURGICAL A
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Mailing Address - Street 1:410 WESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-809-8162
Mailing Address - Fax:985-234-3002
Practice Address - Street 1:1075 HWY 190 E SERVICE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-234-3000
Practice Address - Fax:985-234-3002
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA874363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical