Healthcare Provider Details

I. General information

NPI: 1609396506
Provider Name (Legal Business Name): PRIYA P PATEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRIYA PATEL DPM

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 N 6TH ST
MILWAUKEE WI
53212-3360
US

IV. Provider business mailing address

1271 N 6TH ST
MILWAUKEE WI
53212-3360
US

V. Phone/Fax

Practice location:
  • Phone: 414-978-9100
  • Fax:
Mailing address:
  • Phone: 414-978-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1205-25
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: