=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952606279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIRIT S PATEL MD APMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2011
-----------------------------------------------------
Last Update Date | 01/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 BERT KOUNS INDUSTRIAL LOOP SUITE F
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-3351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-686-1668
-----------------------------------------------------
Fax | 318-686-5821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 BERT KOUNS INDUSTRIAL LOOP SUITE F
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-3351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-686-1668
-----------------------------------------------------
Fax | 318-686-5821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KIRIT PATEL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 318-686-1668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------