Provider Demographics
NPI:1699721050
Name:PATEL, KETAN KAKALBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:KETAN
Middle Name:KAKALBHAI
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 1:5714 C SIGNAL HILL
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2416
Mailing Address - Country:US
Mailing Address - Phone:513-831-4811
Mailing Address - Fax:513-795-0754
Practice Address - Street 1:5714 SIGNAL HILL CT STE C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1459
Practice Address - Country:US
Practice Address - Phone:513-831-4811
Practice Address - Fax:513-795-0754
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9964207R00000X
OH35074670207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2194307Medicaid
OH000000223319OtherANTHEM PIN
OH000000223319OtherANTHEM PIN
OH0875614Medicare ID - Type Unspecified