Healthcare Provider Details

I. General information

NPI: 1861444713
Provider Name (Legal Business Name): SHAILENDRA B PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE IM-ENDOCRINOLOGY
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7400
  • Fax: 513-475-8201
Mailing address:
  • Phone: 513-585-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number48281
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35127413
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: