Provider Demographics
NPI:1316104839
Name:PATEL, JAY B (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:610 N MICHIGAN ST STE 306
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1079
Practice Address - Country:US
Practice Address - Phone:574-647-6500
Practice Address - Fax:574-647-6518
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2017-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01065995A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201301490Medicaid