Healthcare Provider Details

I. General information

NPI: 1023219623
Provider Name (Legal Business Name): SHITEL DINESHBHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GENESIS BLVD # B
WEBSTER TX
77598-1636
US

IV. Provider business mailing address

210 GENESIS BLVD # B
WEBSTER TX
77598-1636
US

V. Phone/Fax

Practice location:
  • Phone: 832-835-1131
  • Fax: 832-918-3223
Mailing address:
  • Phone: 832-835-1131
  • Fax: 832-918-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberP7832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: