Provider Demographics
NPI:1063413052
Name:PATEL, NARESH J (DO)
Entity type:Individual
Prefix:
First Name:NARESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7964 W. JEFFERSON BLVD.
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4140
Mailing Address - Country:US
Mailing Address - Phone:260-436-5670
Mailing Address - Fax:260-436-4706
Practice Address - Street 1:7964 W. JEFFERSON BLVD.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-436-5670
Practice Address - Fax:260-436-4706
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002204A207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271340AMedicaid
G54955Medicare UPIN
047960CMedicare ID - Type Unspecified