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General NPI Number Information
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NPI Number | 1811047020
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Entity Type | Individual
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Provider Name | ANILKUMAR AMBALAL PATEL CERTIFIED SURGICAL A
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1075 HWY 190 E SERVICE ROAD SUITE 200
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City | COVINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 985-234-3000
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Fax | 985-234-3002
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Provider Business Mailing Address
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Address Line | 410 WESTWOOD DRIVE
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City | MANDEVILLE
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State | LA
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Zip | 70471
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Country | US
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Telephone | 985-809-8162
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Fax | 985-234-3002
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 874
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License Number State | LA
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