Provider Demographics
NPI:1366521353
Name:PATEL, SHAILEN R (MD)
Entity type:Individual
Prefix:DR
First Name:SHAILEN
Middle Name:R
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 1:703 TYLER ST
Mailing Address - Street 2:SUITE 252
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-609-8000
Mailing Address - Fax:419-609-8002
Practice Address - Street 1:703 TYLER ST
Practice Address - Street 2:SUITE 252
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-609-8000
Practice Address - Fax:419-609-8002
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088669208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2698282Medicaid
MI4575160Medicaid
MI4575160Medicaid
OH2698282Medicaid
OHPA4200741Medicare PIN