Basic Information
| Provider Information | |||||||||
| NPI: | 1508184201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PALKA | ||||||||
| MiddleName: | RAMANLAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 N LAYTON RD | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460111550 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 ESKENAZI AVENUE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178800000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 263215 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 01072740A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 263215 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 01072740A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 300009244 | 05 | IN | MEDICAID |