Healthcare Provider Details

I. General information

NPI: 1326160896
Provider Name (Legal Business Name): DIPAK R PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. MEDICAL CENTER DR. 3RD FLOOR TAUBMAN CENTER RECP A
ANN ARBOR MI
48109-5370
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-647-5900
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301087891
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301087891
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301087891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: