Healthcare Provider Details

I. General information

NPI: 1891776530
Provider Name (Legal Business Name): KUNTHAVAI S. PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COUNTRY CLUB ROAD
HOUSTON MS
38851
US

IV. Provider business mailing address

208 COUNTRY CLUB ROAD
HOUSTON MS
38851
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-3437
  • Fax: 662-456-2070
Mailing address:
  • Phone: 662-456-3437
  • Fax: 662-456-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMS13688
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: