Basic Information
| Provider Information | |||||||||
| NPI: | 1336123603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | DIPIKA | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MERCHANT STREET | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135331199 | ||||||||
| FaxNumber: | 5136459787 | ||||||||
| Practice Location | |||||||||
| Address1: | 10530 WOLFPEN-PLEASANT HILL RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138317503 | ||||||||
| FaxNumber: | 5138317923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 36003400 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00257869 | 01 | MEDICARE RAILROAD | OTHER | 2607870 | 05 | OH | MEDICAID |