Healthcare Provider Details

I. General information

NPI: 1235151705
Provider Name (Legal Business Name): SURESH K PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 2ND ST
LANGDON ND
58249-2407
US

IV. Provider business mailing address

909 2ND STREET
LANGDON ND
58249
US

V. Phone/Fax

Practice location:
  • Phone: 701-256-6100
  • Fax: 701-256-6156
Mailing address:
  • Phone: 701-256-6100
  • Fax: 701-256-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4196
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: