Healthcare Provider Details

I. General information

NPI: 1164068227
Provider Name (Legal Business Name): DR PRAGNESH PATEL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33811 KING RICHARD DR
STERLING HEIGHTS MI
48310-6348
US

IV. Provider business mailing address

33811 KING RICHARD DR
STERLING HEIGHTS MI
48310-6348
US

V. Phone/Fax

Practice location:
  • Phone: 586-871-7949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PRAGNESH JITENDRA PATEL
Title or Position: EMPLOYEE
Credential: MD
Phone: 586-871-7949