Healthcare Provider Details

I. General information

NPI: 1477948529
Provider Name (Legal Business Name): NEDHI JAGDISH PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2015
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 100
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

100 HOSPITAL LN STE 100
DANVILLE IN
46122-1993
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-7310
  • Fax: 317-745-7320
Mailing address:
  • Phone: 513-584-4505
  • Fax: 513-584-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.026972
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01085626A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: