Healthcare Provider Details

I. General information

NPI: 1477512309
Provider Name (Legal Business Name): KIRIT S PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 BERT KOUNS LOOP STE F
SHREVEPORT LA
71118-3351
US

IV. Provider business mailing address

2120 BERT KOUNS LOOP STE F
SHREVEPORT LA
71118-3351
US

V. Phone/Fax

Practice location:
  • Phone: 318-686-1668
  • Fax: 318-686-5821
Mailing address:
  • Phone: 318-686-1668
  • Fax: 318-686-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberL05690R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberL05690R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: