MEDICARE: KANTILAL S. 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	01043474	IN

General Provider Information

NPI Number	:	1235325085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANTILAL S. PATEL M.D.

Provider Business Mailing Address
First Line	:	525 W CHICAGO AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3206
Country	:	US
Telephone Number	:	219-397-1342
Fax Number	:	219-397-2580

Provider Business Practice Location Address
First Line	:	525 W CHICAGO AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3206
Country	:	US
Telephone Number	:	219-397-1342
Fax Number	:	219-397-2580

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. KANTILAL PATEL
Credential	:	M.D.
Telephone Number	:	219-397-1342

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	11/30/2007

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