Basic Information
| Provider Information | |||||||||
| NPI: | 1427286095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PURVI | ||||||||
| MiddleName: | SURYAKANT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18161 WEST 12 MILE ROAD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Practice Location | |||||||||
| Address1: | 18161 W 12 MILE RD STE 2 | ||||||||
| Address2: | 2 | ||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 08/14/2017 | ||||||||
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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 | 207Q00000X | 4301094535 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.