Provider Demographics
NPI:1124098603
Name:PATEL, PRAVIN P (MD)
Entity type:Individual
Prefix:MR
First Name:PRAVIN
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-1060
Mailing Address - Country:US
Mailing Address - Phone:662-622-7011
Mailing Address - Fax:662-622-0257
Practice Address - Street 1:423 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618
Practice Address - Country:US
Practice Address - Phone:662-622-7011
Practice Address - Fax:662-622-0257
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS07838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015376Medicaid
MS080183850OtherRAILROAD MEDICARE
MS0130244OtherUNITED HEALTH CARE
MS00122592Medicaid
MS080003271Medicare ID - Type Unspecified
D89893Medicare UPIN