MEDICARE: DR. MANISH PRAFULLA 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	208800000X	Urology Physician	200200270	NC
2	208800000X	Urology Physician	TL38968	SC

General Provider Information

NPI Number	:	1578559860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANISH PRAFULLA PATEL M.D.

Provider Business Mailing Address
First Line	:	40 PINNACLE PKWY
Second Line	:	SUITE 104
City	:	ELGIN
State	:	SC
Zip	:	29045-8390
Country	:	US
Telephone Number	:	803-424-8022
Fax Number	:	803-408-8501

Provider Business Practice Location Address
First Line	:	40 PINNACLE PKWY
Second Line	:	SUITE 104
City	:	ELGIN
State	:	SC
Zip	:	29045-8390
Country	:	US
Telephone Number	:	803-424-8022
Fax Number	:	803-408-8501

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/07/2016

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