Basic Information
| Provider Information | |||||||||
| NPI: | 1922036912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NIRMAL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22505 ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | WOODHAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481832237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346716217 | ||||||||
| FaxNumber: | 7346712888 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 W CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BRECKENRIDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486159579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898423118 | ||||||||
| FaxNumber: | 9898421110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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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 | 207Q00000X | 4301080353 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01004494 | 01 | MI | HEALTHPLUS COMMERCIAL | OTHER | 0802911742 | 01 | MI | BCBSM | OTHER | 200000006108 | 01 | MI | PHP COMMERCIAL | OTHER | 1021014 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4890888-10 | 05 | MI | MEDICAID |