Healthcare Provider Details

I. General information

NPI: 1578522793
Provider Name (Legal Business Name): JAGDISH R PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 VIRGINIA AVE STE C
CONNERSVILLE IN
47331-2921
US

IV. Provider business mailing address

1941 VIRGINIA AVE
CONNERSVILLE IN
47331
US

V. Phone/Fax

Practice location:
  • Phone: 765-827-0876
  • Fax: 765-825-6999
Mailing address:
  • Phone: 765-827-7795
  • Fax: 765-827-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71000824A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: