Provider Demographics
NPI:1699759449
Name:PATEL, SHIRAZ KHUSHROO (MD)
Entity type:Individual
Prefix:
First Name:SHIRAZ
Middle Name:KHUSHROO
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 1:3530 LONE OAK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5752
Mailing Address - Country:US
Mailing Address - Phone:270-554-0505
Mailing Address - Fax:270-554-0905
Practice Address - Street 1:200 CLINT HILL BLVD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6768
Practice Address - Country:US
Practice Address - Phone:270-442-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40786207X00000X
KY41151207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN957519700Medicaid