MEDICARE: PREMIER 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

General Provider Information

NPI Number	:	1467160622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER MD

Provider Business Mailing Address
First Line	:	5976 TRAFALGAR CT
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-8310
Country	:	US
Telephone Number	:	614-404-1626
Fax Number	:	888-388-7188

Provider Business Practice Location Address
First Line	:	5919 BLUE STAR DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7595
Country	:	US
Telephone Number	:	614-404-1626
Fax Number	:	888-388-7188

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BHAVESH PATEL
Credential	:	MD
Telephone Number	:	614-404-1626

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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