Provider Demographics
NPI:1699087742
Name:PATEL, KIRAN (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
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 1:34TH ST. & CIVIC CENTER BLVD
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-2437
Mailing Address - Fax:215-590-2768
Practice Address - Street 1:2660 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5803
Practice Address - Country:US
Practice Address - Phone:404-785-8330
Practice Address - Fax:404-785-8390
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA745592080P0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology