Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101020534 | MI |
Y | 207P00000X | Emergency Physician | R0096 | TX |
NPI | 1013353812 |
---|---|
Provider Name | Kevin Praful Patel |
First Address | Kalamazoo, MI 49008-1282 |
Second Address | Canton, TX 75103-3593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190917808 | (05) | TX |
1L2543 | MEDICARE (01) | TX |