Provider Demographics
NPI:1831157056
Name:PATEL, ANIL R (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANILKUMAR
Other - Middle Name:R
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1205 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3548
Mailing Address - Country:US
Mailing Address - Phone:810-985-8144
Mailing Address - Fax:810-985-9020
Practice Address - Street 1:1205 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3548
Practice Address - Country:US
Practice Address - Phone:810-985-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAP044104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110012474OtherRAILROAD MEDICARE NUMBER
MI1107408741OtherBCBSM PROVIDER NUMBER
MI72093AOtherHAP
MI107398OtherCARE CHOICES
MI4071398OtherAETNA PROVIDER NUMBER
MAB47461Medicare UPIN
MI4071398OtherAETNA PROVIDER NUMBER