Basic Information
| Provider Information | |||||||||
| NPI: | 1487659850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | MANUBHAI | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 N STATE ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392022002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013552485 | ||||||||
| FaxNumber: | 6013531463 | ||||||||
| Practice Location | |||||||||
| Address1: | 2969 CURRAN DR N | ||||||||
| Address2: | STE 200 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019745600 | ||||||||
| FaxNumber: | 6019745699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 14074 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 5275585 | 01 | AETNA HEALTHCARE | OTHER | 00118200 | 05 | MS | MEDICAID |