Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125072237 | IN |
NPI | 1083107544 |
---|---|
Provider Name | Ajay Patel |
First Address | Indianapolis, IN 46202-2274 |
Second Address | Indianapolis, IN 46202-2274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2018 |
Last Update Date | 24/06/2019 |