Provider Demographics
NPI:1306286935
Name:PATEL, MEHUL N
Entity type:Individual
Prefix:
First Name:MEHUL
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 104TH AVE UNIT H
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8302
Mailing Address - Country:US
Mailing Address - Phone:262-914-5735
Mailing Address - Fax:
Practice Address - Street 1:7111 104TH AVE UNIT H
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8302
Practice Address - Country:US
Practice Address - Phone:262-914-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16919-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist