Provider Demographics
NPI:1316911837
Name:PATEL, SHAILESH V (MD)
Entity type:Individual
Prefix:MR
First Name:SHAILESH
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8613 MS HIGHWAY 12
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-8917
Mailing Address - Country:US
Mailing Address - Phone:662-456-5008
Mailing Address - Fax:662-456-5417
Practice Address - Street 1:8613 MS HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-8917
Practice Address - Country:US
Practice Address - Phone:662-285-9460
Practice Address - Fax:662-285-9324
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112963Medicaid
MS512I930169Medicare Oscar/Certification
MS00112963Medicaid