Provider Demographics
NPI:1093395519
Name:PATEL, GUNJAN KANAIYALAL (DO)
Entity type:Individual
Prefix:
First Name:GUNJAN
Middle Name:KANAIYALAL
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 1:1481 RICHARDSON RD STE 118
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-8073
Mailing Address - Country:US
Mailing Address - Phone:919-385-5650
Mailing Address - Fax:919-385-9341
Practice Address - Street 1:1481 RICHARDSON RD STE 118
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-8073
Practice Address - Country:US
Practice Address - Phone:919-385-5650
Practice Address - Fax:919-385-9341
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty