Provider Demographics
NPI:1831369040
Name:PATEL, MITESH BABUBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:MITESH
Middle Name:BABUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MITESHKUMAR
Other - Middle Name:BABUBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6439 GARNERS FERRY RD
Mailing Address - Street 2:WJB DORN VA
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1638
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:WJB DORN VA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125048979207R00000X
MOFP2273097207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine