Healthcare Provider Details

I. General information

NPI: 1073695631
Provider Name (Legal Business Name): VIVEK R PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VETERANS DR
WILMORE KY
40390-9775
US

IV. Provider business mailing address

2429 ASTARITA WAY
LEXINGTON KY
40509-4464
US

V. Phone/Fax

Practice location:
  • Phone: 859-858-2814
  • Fax: 859-858-4039
Mailing address:
  • Phone: 859-263-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34037
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: