Provider Demographics
NPI:1720657083
Name:PATEL, PUNIT KAMLESH
Entity type:Individual
Prefix:
First Name:PUNIT
Middle Name:KAMLESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9032 TYNE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7501
Mailing Address - Country:US
Mailing Address - Phone:817-287-8044
Mailing Address - Fax:
Practice Address - Street 1:2634 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-9600
Practice Address - Country:US
Practice Address - Phone:833-483-7800
Practice Address - Fax:833-483-7800
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2196895291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory