Healthcare Provider Details

I. General information

NPI: 1275905515
Provider Name (Legal Business Name): CHIRAG PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13157 1/2 SCHAVEY RD
DEWITT MI
48820-9016
US

IV. Provider business mailing address

35253 VALLEY FORGE DR
FARMINGTON HILLS MI
48331-4619
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-2156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: