Healthcare Provider Details

I. General information

NPI: 1336459619
Provider Name (Legal Business Name): KALYANI RONAK PATEL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL, DEPT OF PATHOL & LAB MED
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL, DEPT OF PATHOL & LAB MED
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2010013473
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number60381323
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: