MEDICARE: DR. PRATIKKUMAR PATEL M.D.M.P.H

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	208000000X	Pediatrics Physician	27506	WV
2	390200000X	Student in an Organized Health Care Education/Training Program	BP10040436	TX
3	2080P0206X	Pediatric Gastroenterology Physician	27506	WV

General Provider Information

NPI Number	:	1467747527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRATIKKUMAR PATEL M.D.M.P.H

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:	SUITE 3.137
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 PENNSYLVANIA AVE STE 401
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3390
Country	:	US
Telephone Number	:	304-388-1552
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	07/03/2017

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Directions to “ DR. PRATIKKUMAR PATEL M.D.M.P.H” Practice Location

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