Healthcare Provider Details

I. General information

NPI: 1285129387
Provider Name (Legal Business Name): TIRTH R PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 S MOORLAND RD
NEW BERLIN WI
53151-7401
US

IV. Provider business mailing address

4805 S MOORLAND RD
NEW BERLIN WI
53151-7401
US

V. Phone/Fax

Practice location:
  • Phone: 414-798-7200
  • Fax: 414-798-7271
Mailing address:
  • Phone: 414-798-7200
  • Fax: 414-798-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number87827-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: