Provider Demographics
NPI:1861600561
Name:PATEL, LATA (DO)
Entity type:Individual
Prefix:
First Name:LATA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40555 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4083
Mailing Address - Country:US
Mailing Address - Phone:877-423-1330
Mailing Address - Fax:586-276-4005
Practice Address - Street 1:40555 UTICA RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4083
Practice Address - Country:US
Practice Address - Phone:877-423-1330
Practice Address - Fax:586-276-4005
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116306Medicaid