Healthcare Provider Details

I. General information

NPI: 1053416453
Provider Name (Legal Business Name): KIRANCHANDRA MAGANLAL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15419 ROCKY OAK CT
HOUSTON TX
77059-3128
US

IV. Provider business mailing address

9235 KATY FWY STE 400
HOUSTON TX
77024-1507
US

V. Phone/Fax

Practice location:
  • Phone: 713-436-9800
  • Fax: 713-436-5551
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-932-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK6680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: