Healthcare Provider Details

I. General information

NPI: 1699087742
Provider Name (Legal Business Name): KIRAN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 SATELLITE BLVD
DULUTH GA
30096-5803
US

IV. Provider business mailing address

34TH ST. & CIVIC CENTER BLVD THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55
PHILADELPHIA PA
19104-4399
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-8330
  • Fax: 404-785-8390
Mailing address:
  • Phone: 215-590-2437
  • Fax: 215-590-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74559
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number74559
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: