Healthcare Provider Details

I. General information

NPI: 1902826936
Provider Name (Legal Business Name): VIKRAM M. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 E MAIN STREET
GREENWOOD IN
46143-1407
US

IV. Provider business mailing address

P.O. BOX 945
GREENWOOD IN
46142-0945
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-1333
  • Fax: 317-887-1333
Mailing address:
  • Phone: 317-887-1333
  • Fax: 317-887-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01031501
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01031501A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: