MEDICARE: PANKTI A 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	01098229A	IN
2	207R00000X	Internal Medicine Physician	4301119163	MI

General Provider Information

NPI Number	:	1770961021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANKTI A PATEL M.D

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 E DUPONT RD STE 3
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-672-6590
Fax Number	:	260-672-6599

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

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	12/01/2025

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