Provider Demographics
NPI:1386747749
Name:P B PATEL MD PROFESSIONAL
Entity type:Organization
Organization Name:P B PATEL MD PROFESSIONAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY FOR THE CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-0185
Mailing Address - Street 1:1011 EAST SAINT MAARTENS DR
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-0185
Mailing Address - Fax:816-364-6225
Practice Address - Street 1:1011 EAST SAINT MAARTENS DR
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-0185
Practice Address - Fax:816-364-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508030004Medicaid
MO508030004Medicaid