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NPI Code Detail

MEDICARE: MITULKUMAR P PATEL M.D.

MEDICARE: MITULKUMAR P PATEL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician10855NV
2207R00000XInternal Medicine PhysicianG74858CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2CS12512OTHERNVPHARMACY/CONTROLLED SUBSTANCE CERTIFICATE
310855OTHERNVMEDICAL LICENSE

General Provider Information

NPI Number : 1093701674
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITULKUMAR P PATEL M.D.
Provider Business Mailing Address
First Line : PO BOX 1737
Second Line :
City : LAS VEGAS
State : NV
Zip : 89125-1737
Country : US
Telephone Number : 702-671-6809
Fax Number : 702-671-6883
Provider Business Practice Location Address
First Line : 4880 WYNN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5406
Country : US
Telephone Number : 702-871-5005
Fax Number : 702-671-6883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 03/07/2023

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Directions to “ MITULKUMAR P PATEL M.D.” Practice Location

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