Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 74559 | GA |
N | 2080P0201X | Pediatric Allergist | 74559 | GA |
NPI | 1699087742 |
---|---|
Provider Name | Kiran Patel |
First Address | Philadelphia, PA 19104-4399 |
Second Address | Duluth, GA 30096-5803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 29/10/2019 |