Healthcare Provider Details

I. General information

NPI: 1154611457
Provider Name (Legal Business Name): AATISH MUKESH PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 E SKELLY DR STE 700
TULSA OK
74135-3256
US

IV. Provider business mailing address

4200 E SKELLY DR STE 700
TULSA OK
74135-3256
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-4700
  • Fax:
Mailing address:
  • Phone: 918-481-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number28400
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: