Provider Demographics
NPI:1528486438
Name:PATEL, KUNAL VIJAYKUMAR (MD)
Entity type:Individual
Prefix:
First Name:KUNAL
Middle Name:VIJAYKUMAR
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 1:3427 CEDAR SPRINGS RD APT 1403
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3260
Mailing Address - Country:US
Mailing Address - Phone:562-650-0811
Mailing Address - Fax:
Practice Address - Street 1:2604 SAINT MICHAEL DR STE 345
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2378
Practice Address - Country:US
Practice Address - Phone:903-838-5500
Practice Address - Fax:903-838-7402
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2453207RI0011X, 207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program