Healthcare Provider Details

I. General information

NPI: 1588859201
Provider Name (Legal Business Name): NIRANJAN SHASHIKANT PATEL,M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 HWY 28 E SUITE E
PINEVILLE LA
71360-5758
US

IV. Provider business mailing address

3113 HWY 28 E SUITE E
PINEVILLE LA
71360-5758
US

V. Phone/Fax

Practice location:
  • Phone: 318-767-2222
  • Fax: 318-767-2264
Mailing address:
  • Phone: 318-767-2222
  • Fax: 318-767-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NIRANJAN SHASHIKANT PATEL
Title or Position: OWNER
Credential: M.D.
Phone: 318-767-2222