Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 02002204A | IN |
NPI | 1063413052 |
---|---|
Provider Name | Naresh J Patel |
First Address | Fort Wayne, IN 46804-4140 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 07/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200271340A | (05) | IN |
G54955 | (02) |