Basic Information
| Provider Information | |||||||||
| NPI: | 1407844111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | AMIT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ANDOVER VIEW LN | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379227706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656713805 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2018 CLINCH AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655418105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 39761 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | 39761 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 287222937A | 05 | GA | MEDICAID |