Basic Information
| Provider Information | |||||||||
| NPI: | 1104288497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATIL | ||||||||
| FirstName: | ABHIJIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12808 W AIRPORT BLVD | ||||||||
| Address2: | STE 275J | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774786245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132345837 | ||||||||
| FaxNumber: | 7137014295 | ||||||||
| Practice Location | |||||||||
| Address1: | 12920 UNIVERSITY BLVD | ||||||||
| Address2: | STE 600 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774796831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133580562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 036.137696 | IL | N | Hospitals | General Acute Care Hospital | 2085R0202X | R8455 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.