MEDICARE: NIMESH MAFAT 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	207R00000X	Internal Medicine Physician	M3057	TX

General Provider Information

NPI Number	:	1740228915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMESH MAFAT PATEL MD

Provider Business Mailing Address
First Line	:	508 MEDICAL CENTER BLVD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2953
Country	:	US
Telephone Number	:	936-523-1402
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 MEDICAL CENTER BLVD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2953
Country	:	US
Telephone Number	:	936-523-1402
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/26/2022

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