Healthcare Provider Details

I. General information

NPI: 1740204957
Provider Name (Legal Business Name): MANISH PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 OLD CEDAR AVE S
BLOOMINGTON MN
55425-1207
US

IV. Provider business mailing address

1021 BANDANA BLVD E SUITE 200
SAINT PAUL MN
55108-5113
US

V. Phone/Fax

Practice location:
  • Phone: 952-851-1000
  • Fax: 952-851-1092
Mailing address:
  • Phone: 651-642-2700
  • Fax: 651-642-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48188
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number48188
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: