Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301097238 | MI |
N | 208D00000X | General Practice Physician | 16488 | NH |
NPI | 1033420419 |
---|---|
Provider Name | Nathan Tushar Patel |
First Address | Pineville, LA 71360-4044 |
Second Address | Kalamazoo, MI 49009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07031983 | DOB (01) |