Healthcare Provider Details

I. General information

NPI: 1710911219
Provider Name (Legal Business Name): HEMANG C. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 NORTH ILLINOIS STREET SUITE 1010
INDIANAPOLIS IN
46290-1164
US

IV. Provider business mailing address

10300 NORTH ILLINOIS STREET SUITE 1010
INDIANAPOLIS IN
46290-1164
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1768
  • Fax: 317-817-1777
Mailing address:
  • Phone: 317-817-1768
  • Fax: 317-817-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number01051177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: