Healthcare Provider Details

I. General information

NPI: 1538324355
Provider Name (Legal Business Name): INDU B PATEL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 METROPOLITAN BLVD
BARNHART MO
63012-1495
US

IV. Provider business mailing address

7105 METROPOLITAN BLVD P.O. BOX 308
BARNHART MO
63012-1495
US

V. Phone/Fax

Practice location:
  • Phone: 636-464-7032
  • Fax: 636-464-5877
Mailing address:
  • Phone: 636-464-7032
  • Fax: 636-464-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR7D52
License Number StateMO

VIII. Authorized Official

Name: INDU B. PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 636-464-7032