Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 29724 | KY |
NPI | 1003891599 |
---|---|
Provider Name | Pradip D Patel |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40272-6809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 05/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200080580 | (05) | IN |
64297245 | (05) | KY |
G23347 | (02) |