Provider Demographics
NPI:1558343434
Name:PATEL, VIJAYKUMAR P (MD)
Entity type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:P
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 1:9711 MOUNTAIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6270
Mailing Address - Country:US
Mailing Address - Phone:423-238-4622
Mailing Address - Fax:
Practice Address - Street 1:9711 MOUNTAIN LAKE DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6270
Practice Address - Country:US
Practice Address - Phone:423-238-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33175207RG0100X
TN20740207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3052531Medicaid
TN3052531Medicare PIN
TND86177Medicare UPIN