MEDICARE: DR. AMIT INDRAVADAN 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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	M3682	TX
2	207VG0400X	Gynecology Physician	M3682	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7323792	OTHER	TX	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8DM546	OTHER	TX	BCBS PROVIDER #

General Provider Information

NPI Number	:	1336131812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT INDRAVADAN PATEL M.D.

Provider Business Mailing Address
First Line	:	3822 BOWSER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4301
Country	:	US
Telephone Number	:	214-604-5440
Fax Number	:	469-440-7400

Provider Business Practice Location Address
First Line	:	2301 MARSH LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8497
Country	:	US
Telephone Number	:	469-999-4519
Fax Number	:	469-440-7400

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	04/10/2014

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