MEDICARE: DR. SUDHA R 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	SP042387	MI

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	:	1013917236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUDHA R PATEL M.D.

Provider Business Mailing Address
First Line	:	49848 COOKE AVE
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-2885
Country	:	US
Telephone Number	:	734-459-4128
Fax Number	:	734-728-1400

Provider Business Practice Location Address
First Line	:	34210 GLENWOOD RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-5439
Country	:	US
Telephone Number	:	734-728-2300
Fax Number	:	734-728-1400

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/03/2008

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