MEDICARE: DIMPAL RASHMIKANT PATEL PA-C

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	363A00000X	Physician Assistant	085-002968	IL
2	363A00000X	Physician Assistant	5601010654	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209119	OTHER	IL	MEDICARE PTAN LOCALITY 16
2	209118	OTHER	IL	MEDICARE PTAN LOCALITY 15

General Provider Information

NPI Number	:	1336343540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMPAL RASHMIKANT PATEL PA-C

Provider Business Mailing Address
First Line	:	311 MACK AVE FL 5
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2466
Country	:	US
Telephone Number	:	313-832-0500
Fax Number	:	313-966-8400

Provider Business Practice Location Address
First Line	:	311 MACK AVE FL 5
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2466
Country	:	US
Telephone Number	:	313-832-0500
Fax Number	:	313-966-8400

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	11/09/2021

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