Healthcare Provider Details

I. General information

NPI: 1366442261
Provider Name (Legal Business Name): UPENDRA H. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8242 CALUMET AVE.
MUNSTER IN
46321-1704
US

IV. Provider business mailing address

1040 SIERRA DR SUITE 400
GREENWOOD IN
46143-7240
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-6166
  • Fax: 219-836-0768
Mailing address:
  • Phone: 317-528-4886
  • Fax: 317-859-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01026776A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01026776A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: