Basic Information
| Provider Information | |||||||||
| NPI: | 1679924229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | KETAN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2703 COY ST | ||||||||
| Address2: | APARTMENT 6 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452191083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136166597 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 W 16TH ST | ||||||||
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| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853644430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283444325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.