Basic Information
| Provider Information | |||||||||
| NPI: | 1689847428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | HIRENKUMAR | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11109 PARKVIEW PLAZA DR # 117 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451701 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 E MANSION ST STE 1E | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490681167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697813938 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME109622 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 01071720A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 000000792408 | 01 | IN | ANTHEM | OTHER | 14E8S | 01 | FL | BCBS | OTHER | P00982103 | 01 | FL | RRMEDICARE | OTHER |