Basic Information
| Provider Information | |||||||||
| NPI: | 1699087742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | KIRAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34TH ST. & CIVIC CENTER BLVD | ||||||||
| Address2: | THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155902437 | ||||||||
| FaxNumber: | 2155902768 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 SATELLITE BLVD | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300965803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047858330 | ||||||||
| FaxNumber: | 4047858390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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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 | 2080P0201X | 74559 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | 208000000X | 74559 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.