Healthcare Provider Details

I. General information

NPI: 1457769218
Provider Name (Legal Business Name): NIRAV PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MORTON BLVD
HAZARD KY
41701-9469
US

IV. Provider business mailing address

750 MORTON BLVD
HAZARD KY
41701
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-6600
  • Fax:
Mailing address:
  • Phone: 606-439-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3584
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number50755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: