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General NPI Number Information
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NPI Number | 1417950510
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Entity Type | Individual
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Provider Name | SANJAY J PATIL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 2139 AUBURN AVE BALDWIN BLDG - 5 SOUTH
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-585-1954
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Fax | 513-585-0607
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Provider Business Mailing Address
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Address Line | 6905 BURLINGTON PIKE SUITE E
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City | FLORENCE
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State | KY
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Zip | 41042-1618
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Country | US
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Telephone | 859-331-0774
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Fax | 859-282-7324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 34438
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License Number State | KY
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