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General NPI Number Information
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NPI Number | 1558640698
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Entity Type | Organization
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Legal Business Name | DR. MITA R. PATEL PC
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 1608 N LEBANON ST
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City | LEBANON
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State | IN
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Zip | 46052-1514
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Country | US
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Telephone | 765-483-0842
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Fax | 765-483-0846
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Provider Business Mailing Address
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Address Line | 1608 N LEBANON ST
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City | LEBANON
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State | IN
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Zip | 46052-1514
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Country | US
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Telephone | 765-483-0842
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Fax | 765-483-0846
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Authorized Official
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Title or Position | OWNER
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Name | DR. MITA PATEL
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Credential | MD
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Telephone | 765-483-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01039025A
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License Number State | IN
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