Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MT224194 | PA |
NPI | 1023506722 |
---|---|
Provider Name | Shivaraj Prakash Patil |
First Address | Philadelphia, PA 19141-3098 |
Second Address | Philadelphia, PA 19141-3018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2018 |
Last Update Date | 12/07/2021 |