Healthcare Provider Details

I. General information

NPI: 1326307109
Provider Name (Legal Business Name): SONAL PATEL MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 89TH AVE STE 2A
MERRILLVILLE IN
46410-7319
US

IV. Provider business mailing address

1837 REDWOOD LANE
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-614-8921
  • Fax:
Mailing address:
  • Phone: 219-614-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001281A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164004689
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: