MEDICARE: VIJAYKUMAR N PATEL MD

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	207Q00000X	Family Medicine Physician	4301065678	MI

General Provider Information

NPI Number	:	1295703866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAYKUMAR N PATEL MD

Provider Business Mailing Address
First Line	:	30900 FORD RD STE B
Second Line	:	SUITE B
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-1892
Country	:	US
Telephone Number	:	734-524-0920
Fax Number	:	734-524-0921

Provider Business Practice Location Address
First Line	:	30900 FORD RD STE B
Second Line	:	SUITE B
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-1892
Country	:	US
Telephone Number	:	734-524-0920
Fax Number	:	734-524-0921

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/25/2013

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