Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301061716 | MI |
NPI | 1205878238 |
---|---|
Provider Name | Dr. Tushar Patel |
First Address | Northville, MI 48168-8582 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G32000 | (02) | MI |
TP061716 | BC/BS OF MICHIGAN (01) | MI |