Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 65141-20 | WI |
NPI | 1033422860 |
---|---|
Provider Name | Dr. Sanjeevkumar Ashok Patel |
First Address | Kirkwood, MO 63122-6485 |
Second Address | Appleton, WI 54911-8735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2010 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100056119 | (05) | WI |