Healthcare Provider Details

I. General information

NPI: 1780944918
Provider Name (Legal Business Name): ABHISHEK PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY STE 430
AUSTIN TX
78705-1023
US

IV. Provider business mailing address

3705 MEDICAL PKWY STE 430
AUSTIN TX
78705-1023
US

V. Phone/Fax

Practice location:
  • Phone: 737-256-5900
  • Fax: 737-667-5011
Mailing address:
  • Phone: 737-256-5900
  • Fax: 737-667-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A16483
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberS7528
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: