MEDICARE: DR. KETAN P PATEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L7098	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003814146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KETAN P PATEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 815639
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75381-5639
Country	:	US
Telephone Number	:	972-888-7240
Fax Number	:	972-888-7285

Provider Business Practice Location Address
First Line	:	4325 N JOSEY LN STE 202
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4637
Country	:	US
Telephone Number	:	214-566-9616
Fax Number	:	307-459-6599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/10/2023

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