MEDICARE: MITTAL C. PATEL MD

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	207Q00000X	Family Medicine Physician	A76093	CA

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	:	1376621870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITTAL C. PATEL MD

Provider Business Mailing Address
First Line	:	2505 SAMARITAN DR
Second Line	:	SUITE 505
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4006
Country	:	US
Telephone Number	:	408-358-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 N JACKSON AVE STE 5
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1606
Country	:	US
Telephone Number	:	408-493-5144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/05/2025

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