Healthcare Provider Details

I. General information

NPI: 1699090860
Provider Name (Legal Business Name): SAMIR VIRENDRA PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 C AVE NE
CEDAR RAPIDS IA
52402-1349
US

IV. Provider business mailing address

790 11TH ST APT 2
MARION IA
52302-3418
US

V. Phone/Fax

Practice location:
  • Phone: 319-832-1463
  • Fax: 319-832-1469
Mailing address:
  • Phone: 319-899-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-42159
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-42159
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: