MEDICARE: MUKESH 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
1	207R00000X	Internal Medicine Physician	MD038589L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194019166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUKESH PATEL M.D

Provider Business Mailing Address
First Line	:	1421 LINCOLN AVE
Second Line	:
City	:	PROSPECT PARK
State	:	PA
Zip	:	19076-1107
Country	:	US
Telephone Number	:	610-532-5343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 LINCOLN AVE
Second Line	:
City	:	PROSPECT PARK
State	:	PA
Zip	:	19076-1107
Country	:	US
Telephone Number	:	610-532-5343
Fax Number	:

Authorized Official
Title or Position	:	DR
Name	:	DR. MUKESH A PATEL
Credential	:	M.D
Telephone Number	:	610-532-5343

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	06/07/2011

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