Healthcare Provider Details

I. General information

NPI: 1487874244
Provider Name (Legal Business Name): MIHIR R. PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE FL STREET11
ATLANTA GA
30308-2247
US

IV. Provider business mailing address

550 PEACHTREE ST NE FL STREET11
ATLANTA GA
30308-2247
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-0152
  • Fax: 404-778-4295
Mailing address:
  • Phone: 404-778-0152
  • Fax: 404-778-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD448787
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number072072
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number072072
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: