Healthcare Provider Details

I. General information

NPI: 1295710655
Provider Name (Legal Business Name): ANANT I PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 02/01/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12180 N MOPAC EXPY STE B
AUSTIN TX
78758-2909
US

IV. Provider business mailing address

12180 N MOPAC EXPY STE B
AUSTIN TX
78758-2909
US

V. Phone/Fax

Practice location:
  • Phone: 512-617-2810
  • Fax: 512-814-0018
Mailing address:
  • Phone: 512-617-6767
  • Fax: 512-617-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberK4982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: