Healthcare Provider Details

I. General information

NPI: 1588244792
Provider Name (Legal Business Name): RAJ PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11885 E 12 MILE RD STE 300A
WARREN MI
48093-3467
US

IV. Provider business mailing address

25 SEMINARY DR
MAHWAH NJ
07430-2556
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-6630
  • Fax: 586-582-6631
Mailing address:
  • Phone: 201-257-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: