Healthcare Provider Details

I. General information

NPI: 1629323175
Provider Name (Legal Business Name): KINJAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13521 STEELECROFT PKWY STE B
CHARLOTTE NC
28278-7889
US

IV. Provider business mailing address

1190 HIGHWAY 9 BYP W
LANCASTER SC
29720-1709
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-1411
  • Fax:
Mailing address:
  • Phone: 803-285-1411
  • Fax: 803-283-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number655
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number65P84883
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number655
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: