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General NPI Number Information
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NPI Number | 1215102116
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Entity Type | Organization
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Legal Business Name | B. G. PATEL, M.D. PLC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 6770 DIXIE HWY STE 303
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City | CLARKSTON
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State | MI
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Zip | 48346-2087
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Country | US
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Telephone | 248-625-0030
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Fax | 248-625-4403
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Provider Business Mailing Address
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Address Line | 6770 DIXIE HWY STE 303
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City | CLARKSTON
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State | MI
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Zip | 48346-2087
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Country | US
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Telephone | 248-625-0030
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Fax | 248-625-4403
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. DEBORAH LYNN DELAP
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Credential | LPN
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Telephone | 248-625-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301040083
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License Number State | MI
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