MEDICARE: DR. SANJAY J PATIL 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	207RC0000X	Cardiovascular Disease Physician	34438	KY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417950510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY J PATIL M.D.

Provider Business Mailing Address
First Line	:	6905 BURLINGTON PIKE
Second Line	:	SUITE E
City	:	FLORENCE
State	:	KY
Zip	:	41042-1618
Country	:	US
Telephone Number	:	859-331-0774
Fax Number	:	859-282-7324

Provider Business Practice Location Address
First Line	:	2139 AUBURN AVE
Second Line	:	BALDWIN BLDG - 5 SOUTH
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:	513-585-1954
Fax Number	:	513-585-0607

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/21/2011

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