Basic Information
Provider Information | |||||||||
NPI: | 1285935734 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PATEL | ||||||||
FirstName: | NIHAR | ||||||||
MiddleName: | ARVIND | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1345 UNITY PLACE | ||||||||
Address2: | SUITE 345 | ||||||||
City: | LAFAYETTE | ||||||||
State: | IN | ||||||||
PostalCode: | 479055761 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7654465111 | ||||||||
FaxNumber: | 7658380972 | ||||||||
Practice Location | |||||||||
Address1: | 1345 UNITY PLACE | ||||||||
Address2: | SUITE 345 | ||||||||
City: | LAFAYETTE | ||||||||
State: | IN | ||||||||
PostalCode: | 479055761 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7654465111 | ||||||||
FaxNumber: | 7658380972 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2010 | ||||||||
LastUpdateDate: | 03/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT196160 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RH0003X | MD446202 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 35.133042 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 0326668 | 05 | OH |   | MEDICAID | 300046055 | 05 | IN |   | MEDICAID | 102741774 | 05 | PA |   | MEDICAID |