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General NPI Number Information
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NPI Number | 1790160323
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Entity Type | Organization
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Legal Business Name | KUNAL K. PATRA, M.D., P.C.
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 211 SIOUX POINT ROAD
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5092
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Country | US
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Telephone | 712-574-9936
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Fax |
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Provider Business Mailing Address
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Address Line | 410 BAYHILL CIR
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5092
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Country | US
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Telephone | 605-232-2082
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KUNAL K PATRA
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Credential | M.D.
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Telephone | 712-574-9936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9089
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License Number State | SD
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