Provider Demographics
NPI:1487741062
Name:PATIL, KISHOR K (MD)
Entity type:Individual
Prefix:
First Name:KISHOR
Middle Name:K
Last Name:PATIL
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 1:5509 KIRKWOOD HWY
Mailing Address - Street 2:6
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5001
Mailing Address - Country:US
Mailing Address - Phone:302-636-0936
Mailing Address - Fax:
Practice Address - Street 1:5509 KIRKWOOD HWY
Practice Address - Street 2:6
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5001
Practice Address - Country:US
Practice Address - Phone:302-636-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA649492084N0400X
DEC100045302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G12467Medicare UPIN
NJ035935NVSMedicare ID - Type Unspecified