=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164653812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUNITI DILIPBHAI PATEL DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2009
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 BLOSSOM ST
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-317-6117
-----------------------------------------------------
Fax | 832-772-7201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 BLOSSOM ST
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-317-6117
-----------------------------------------------------
Fax | 832-772-7201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 1989
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------