Healthcare Provider Details

I. General information

NPI: 1144194176
Provider Name (Legal Business Name): MSM6 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MYSTIC LN FL 2 SUITE #B
MALVERN PA
19355-1942
US

IV. Provider business mailing address

20 MYSTIC LN FL 2 SUITE #B
MALVERN PA
19355-1942
US

V. Phone/Fax

Practice location:
  • Phone: 224-829-9901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GAURAV PATEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 484-320-7374