Provider Demographics
NPI:1992767750
Name:PATEL, VIRENDRA C (MD)
Entity type:Individual
Prefix:DR
First Name:VIRENDRA
Middle Name:C
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 1:4637 SHELL CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7144
Mailing Address - Country:US
Mailing Address - Phone:620-331-2725
Mailing Address - Fax:214-575-2664
Practice Address - Street 1:1120 W CAMPBELL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2976
Practice Address - Country:US
Practice Address - Phone:214-575-2663
Practice Address - Fax:214-575-2664
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419853174400000X
TXN4654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100196990AMedicaid
TXTXB165405OtherMEDICARE
KSC10103Medicare UPIN
KS104450Medicare ID - Type UnspecifiedMEDICARE