Provider Demographics
NPI:1841368222
Name:PATEL, AKXAY S (DO)
Entity type:Individual
Prefix:
First Name:AKXAY
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2792
Mailing Address - Country:US
Mailing Address - Phone:765-482-7005
Mailing Address - Fax:765-483-2517
Practice Address - Street 1:1310 S LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2792
Practice Address - Country:US
Practice Address - Phone:765-482-7005
Practice Address - Fax:765-483-2517
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI50787021207Q00000X
IN02004236A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30005655Medicaid
NY01970350Medicaid
NYH03119Medicare UPIN