Basic Information
| Provider Information | |||||||||
| NPI: | 1891836920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | MITUL | ||||||||
| MiddleName: | KANTI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3024 BUSINESS PARK CIR | ||||||||
| Address2: | |||||||||
| City: | GOODLETTSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370723132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158516033 | ||||||||
| FaxNumber: | 6158512018 | ||||||||
| Practice Location | |||||||||
| Address1: | 5651 FRIST BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158850200 | ||||||||
| FaxNumber: | 6158850267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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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 | 174400000X | MD0000037381 | TN | N | Other Service Providers | Specialist | 207X00000X | 37381 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64063795 | 05 | KY | MEDICAID | 9303776 | 01 | CIGNA | OTHER | 4343269 | 01 | TN | BCBS TN | OTHER | 5473141 | 01 | FIRST HEALTH | OTHER | 201221325 | 01 | UNITED HEALTHCARE | OTHER | 3884156 | 05 | TN | MEDICAID | Q000660 | 05 | TN | MEDICAID | 201221325 | 01 | HEALTHSPRING | OTHER | 201221325 | 01 | TRICARE | OTHER | 7587475 | 01 | AETNA | OTHER | 201221325 | 01 | GREAT WEST HEALTHCARE | OTHER | 4091543 | 01 | TN | BLUECROSS | OTHER |