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General NPI Number Information
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NPI Number | 1588042600
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Entity Type | Individual
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Provider Name | NIRAV MAHENDRAKUMAR PATEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 1850 STATE ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-4990
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Country | US
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Telephone | 812-949-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 914 W BLOOMINGTON RD APT 146
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City | CHAMPAIGN
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State | IL
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Zip | 61821-1725
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Country | US
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Telephone | 217-597-9636
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Fax |
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 02005986A
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License Number State | IN
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