Healthcare Provider Details

I. General information

NPI: 1013597863
Provider Name (Legal Business Name): DEVEN BIPIN PATEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 FERGUSON DR STE 150
CINCINNATI OH
45245-1760
US

IV. Provider business mailing address

4357 FERGUSON DR STE 150
CINCINNATI OH
45245-1760
US

V. Phone/Fax

Practice location:
  • Phone: 513-474-4450
  • Fax: 513-474-6387
Mailing address:
  • Phone: 513-474-4450
  • Fax: 513-474-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.004137
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number59.000890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: