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General NPI Number Information
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NPI Number | 1629654132
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Entity Type | Individual
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Provider Name | PRAYAG R PATEL
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 2450 CORAL CT
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City | CORALVILLE
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State | IA
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Zip | 52241-2975
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Country | US
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Telephone | 708-768-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 W 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1991
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Country | US
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Telephone | 317-338-6399
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Fax | 317-338-6359
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | DO-06944
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License Number State | IA
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