MEDICARE: DR. SURESH 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	207RC0000X	Cardiovascular Disease Physician	E1749	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	187046	OTHER	NY	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	E1749	OTHER	AR	STATE LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588669006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH PATEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:	870-347-3492

Provider Business Practice Location Address
First Line	:	2816 FOX MEADOW LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-9346
Country	:	US
Telephone Number	:	870-336-1675
Fax Number	:	870-336-1679

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/07/2023

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