Provider Demographics
NPI:1285914069
Name:RAKESH PATEL M.D. P. A.
Entity type:Organization
Organization Name:RAKESH PATEL M.D. P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-470-4700
Mailing Address - Street 1:10611 W FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6006
Mailing Address - Country:US
Mailing Address - Phone:281-470-4700
Mailing Address - Fax:281-470-8787
Practice Address - Street 1:10611 W FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6006
Practice Address - Country:US
Practice Address - Phone:281-470-4700
Practice Address - Fax:281-470-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2091261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121426402Medicaid
TX121426404Medicaid
TX0016EWOtherBLUE CROSS BLUE SHIELD
TX00238MOtherMEDICARE PTAN
TX10021892OtherAMERIGROUP
TXG69377Medicare UPIN