Healthcare Provider Details

I. General information

NPI: 1437654902
Provider Name (Legal Business Name): DIMPAL PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC2004
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE # MLC2004
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 136-364-7705
  • Fax: 513-636-3847
Mailing address:
  • Phone: 136-364-7705
  • Fax: 513-636-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005521RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: