Healthcare Provider Details

I. General information

NPI: 1124010426
Provider Name (Legal Business Name): VASANT PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S HOSPITAL DR
MURPHYSBORO IL
62966-3333
US

IV. Provider business mailing address

PO BOX 1105
INDIANAPOLIS IN
46206-1105
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-1035
  • Fax: 618-684-1036
Mailing address:
  • Phone: 618-549-5361
  • Fax: 618-639-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39368
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0099133
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036135386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: