Provider Demographics
NPI:1215233192
Name:PATEL, MITUL NATU (MD)
Entity type:Individual
Prefix:DR
First Name:MITUL
Middle Name:NATU
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 1:200 PORTRAIT ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2704
Mailing Address - Country:US
Mailing Address - Phone:318-541-0063
Mailing Address - Fax:
Practice Address - Street 1:1490 HIGHWAY 72 E
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-1508
Practice Address - Country:US
Practice Address - Phone:318-541-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054864207R00000X
MT56341207RN0300X
LA312321207RN0300X
ALMD43845207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2500244Medicaid