MEDICARE: VIJESH K. PATEL. M.D., PA

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
1	207R00000X	Internal Medicine Physician	K1616	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0084RF	OTHER	TX	BCBS GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154366938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIJESH K. PATEL. M.D., PA

Provider Business Mailing Address
First Line	:	876 MAGNOLIA AVE
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-3712
Country	:	US
Telephone Number	:	409-729-3787
Fax Number	:	409-722-8660

Provider Business Practice Location Address
First Line	:	876 MAGNOLIA AVE
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-3712
Country	:	US
Telephone Number	:	409-729-3787
Fax Number	:	409-722-8660

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	VIJESH K PATEL
Credential	:	M.D.
Telephone Number	:	409-729-3787

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	10/23/2013

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