Basic Information
| Provider Information | |||||||||
| NPI: | 1861740193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PURVI S PATEL, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18161 W 12 MILE RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Practice Location | |||||||||
| Address1: | 18161 W 12 MILE RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2012 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | PURVI | ||||||||
| AuthorizedOfficialMiddleName: | SURYAKANT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4402895828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301094535 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.