Basic Information
| Provider Information | |||||||||
| NPI: | 1912088808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | BHARGAVI | ||||||||
| MiddleName: | KANUBHAI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MB BS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12018 TINDALL DR | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144322951 | ||||||||
| FaxNumber: | 3144322986 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 EAST CHERRY STREET | ||||||||
| Address2: | LINCOLN COUNTY MEDICAL CENTER DEPT OF RADIOLOGY | ||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365283348 | ||||||||
| FaxNumber: | 6365285431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | R6799 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | AP9772939 | 01 | DC | DEA | OTHER |