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General NPI Number Information
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NPI Number | 1659841120
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Entity Type | Individual
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Provider Name | JALDIPKUMAR M PATANKAR
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Gender | Male
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 1663 STEPHENSON HWY
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City | TROY
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State | MI
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Zip | 48083-2169
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Country | US
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Telephone | 248-247-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 449 SANDALWOOD RD
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City | CANTON
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State | MI
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Zip | 48188-3028
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Country | US
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Telephone | 248-875-2995
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013889
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License Number State | MI
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