Healthcare Provider Details

I. General information

NPI: 1255688255
Provider Name (Legal Business Name): MANISH K PATEL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 HIGHWAY 6 STE 304
SUGAR LAND TX
77478-5135
US

IV. Provider business mailing address

PO BOX 941388
HOUSTON TX
77094-8388
US

V. Phone/Fax

Practice location:
  • Phone: 832-500-1345
  • Fax: 713-273-5849
Mailing address:
  • Phone: 832-500-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2021
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: