Healthcare Provider Details

I. General information

NPI: 1336131812
Provider Name (Legal Business Name): AMIT INDRAVADAN PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 MARSH LN
PLANO TX
75093-8497
US

IV. Provider business mailing address

3822 BOWSER AVE
DALLAS TX
75219-4301
US

V. Phone/Fax

Practice location:
  • Phone: 469-999-4519
  • Fax: 469-440-7400
Mailing address:
  • Phone: 214-604-5440
  • Fax: 469-440-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberM3682
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberM3682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: