MEDICARE: MITESH SUBHASH 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	207R00000X	Internal Medicine Physician	MT194635	PA
2	207R00000X	Internal Medicine Physician	MD444032	PA

General Provider Information

NPI Number	:	1336383215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITESH SUBHASH PATEL MD

Provider Business Mailing Address
First Line	:	423 GUARDIAN DR
Second Line	:	13TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4865
Country	:	US
Telephone Number	:	734-355-0817
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 GUARDIAN DRIVE
Second Line	:	13TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6021
Country	:	US
Telephone Number	:	734-355-0817
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	07/30/2012

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