Healthcare Provider Details

I. General information

NPI: 1699185249
Provider Name (Legal Business Name): KUNJ G PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 DUNCAN AVE STE 8N
SAINT LOUIS MO
63110-1111
US

IV. Provider business mailing address

3909 CASTELLINA WAY
MANTECA CA
95337-8454
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-7246
  • Fax: 301-579-4284
Mailing address:
  • Phone: 314-282-7246
  • Fax: 301-579-4284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number274535
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036.150024
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2019016517
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2019016517
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.150024
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036.150024
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2019016517
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: