MEDICARE: DR. KANUBHAI M 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	207R00000X	Internal Medicine Physician	036-048978	IL
2	207RC0000X	Cardiovascular Disease Physician	036-048978	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649278185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KANUBHAI M PATEL M.D.

Provider Business Mailing Address
First Line	:	3165 MYRTLE AVE
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5012
Country	:	US
Telephone Number	:	618-877-3066
Fax Number	:	618-877-3060

Provider Business Practice Location Address
First Line	:	3165 MYRTLE AVE
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5012
Country	:	US
Telephone Number	:	618-877-3066
Fax Number	:	618-877-3060

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	05/12/2008

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