MEDICARE: PREMAL P. 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	207Q00000X	Family Medicine Physician	L9420	TX

General Provider Information

NPI Number	:	1841432390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMAL P. PATEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 820605
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-0605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8521 HIGH POINT CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-1384
Country	:	US
Telephone Number	:	254-498-7874
Fax Number	:

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

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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