Healthcare Provider Details

I. General information

NPI: 1669821187
Provider Name (Legal Business Name): REENA PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 POPLAR AVE STE 300
MEMPHIS TN
38119-4810
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 800-999-1249
  • Fax:
Mailing address:
  • Phone: 800-999-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number6091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: