Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 49352 | KY |
N | 2080P0202X | Pediatric Cardiologist | 49352 | KY |
NPI | 1104147891 |
---|---|
Provider Name | Dr. Siddharth Patel |
First Address | Mayfield, KY 42066-1194 |
Second Address | Mayfield, KY 42066-1194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 29/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2329502 | (05) | LA |