Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301090674 | MI |
N | 207RI0011X | Interventional Cardiology | 2017-00287 | NC |
N | 207RI0011X | Interventional Cardiology | 25416 | MS |
N | 207RI0011X | Interventional Cardiology | 4301090674 | MI |
Y | 207RI0011X | Interventional Cardiology | 57119 | TN |
NPI | 1003097593 |
---|---|
Provider Name | Mehul B Patel |
First Address | Memphis, TN 38148-0001 |
Second Address | Germantown, TN 38138-1760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003097593 | (05) | NC |
19PHV | BCBS OF NC (01) | NC |
NCX167A | MEDICARE (01) | NC |