Provider Demographics
NPI:1528123072
Name:PATEL, SHAILESH MANEKLAL (MD)
Entity type:Individual
Prefix:
First Name:SHAILESH
Middle Name:MANEKLAL
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 1:2880 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9171
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:2880 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-797-5050
Practice Address - Fax:843-797-3633
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29727207X00000X, 208100000X, 208VP0000X, 208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30165827OtherSELECT HEALTH PROVIDER ID
SC220471OtherMEDCOST PROVIDER NO.
SCD043OtherARCIS HEALTHCARE MEDICARE GROUP PTAN
SCDE3528OtherMEDICAID DME PTAN
SC7623566OtherCIGNA PROVIDER ID
SC965426OtherWELLCARE PROVIDER ID
SCAA20541701OtherMEDICARE GROUP
SCP01291314OtherRAILROAD MEDICARE PTAN
SC1902246077OtherARCIS HEALTHCARE GROUP NPI
SC42D2000692OtherARCIS HEALTHCARE CLIA CERTIFICATION NO.
SCDE3538OtherMEDICAID DME PTAN
SCDU4331OtherRAILROAD MEDICARE GROUP PTAN
SC4271747 / 1572888OtherCOVENTRY NETWORKS PROVIDER NO. & CPD ID NO.
SC56162OtherMEDCOST GROUP PAYER ID
SCDE3537OtherMEDICAID DME PTAN
SC45168OtherMULTIPLAN GROUP NO.
SC570634057OtherGROUP TAX ID
SC9343063OtherAETNA PROVIDER ID
SCDE3694OtherMEDICAID DME PTAN
SCGP6337OtherARCIS HEALTHCARE MEDICAID GROUP PTAN
SCAA2054OtherMEDICARE NUMBER
SCDE3539OtherMEDICAID DME PTAN
SCGP6337OtherARCIS HEALTHCARE MEDICAID GROUP PTAN
SCDE3694OtherMEDICAID DME PTAN
SC45168OtherMULTIPLAN GROUP NO.
SCDE3528OtherMEDICAID DME PTAN
SC7000950006Medicare NSC
SCDE3694OtherMEDICAID DME PTAN
SCAA20541701OtherMEDICARE GROUP