Healthcare Provider Details

I. General information

NPI: 1629175989
Provider Name (Legal Business Name): PARAG GANAPATI PATIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N RIVERSIDE RD STE 150
SAINT JOSEPH MO
64507-2508
US

IV. Provider business mailing address

802 N RIVERSIDE RD STE 150
SAINT JOSEPH MO
64507-2508
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-4025
  • Fax: 816-271-4026
Mailing address:
  • Phone: 816-271-4025
  • Fax: 816-271-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025042674
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number29737
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301086873
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: