Healthcare Provider Details

I. General information

NPI: 1386682441
Provider Name (Legal Business Name): PRAGNESH PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST ANTOINE, STE 5B DRH ROSA PARKS WELLNESS INSTITUTE FOR SR HEALTH
DETROIT MI
48201-2153
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400-CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1741
  • Fax: 313-745-8165
Mailing address:
  • Phone: 313-745-1741
  • Fax: 313-745-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301070713
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301070713
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number4301070713
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: