Provider Demographics
NPI:1932262433
Name:PATEL, SUKETU (DO)
Entity type:Individual
Prefix:
First Name:SUKETU
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 WILLIAMS DR
Mailing Address - Street 2:SUITE, 177
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2764
Mailing Address - Country:US
Mailing Address - Phone:512-868-3376
Mailing Address - Fax:512-869-5868
Practice Address - Street 1:3010 WILLIAMS DR
Practice Address - Street 2:SUITE 177
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2764
Practice Address - Country:US
Practice Address - Phone:512-868-3376
Practice Address - Fax:512-869-5868
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229989207ZP0102X
VA390200000X
MDH0092858207N00000X
TXN7325207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology