MEDICARE: PIYUSH C 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	2085R0202X	Diagnostic Radiology Physician	4301039145	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300020172	OTHER		RAILROAD MEDICARE

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	4301039145	OTHER	MI	STATE OF MICHIGAN MEDICAL LICENSE
3	3003800411	OTHER	MI	BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1770584948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIYUSH C PATEL M.D.

Provider Business Mailing Address
First Line	:	2800 SPRING ARBOR RD STE 102
Second Line	:	PO BOX 905
City	:	JACKSON
State	:	MI
Zip	:	49203-3895
Country	:	US
Telephone Number	:	517-783-2612
Fax Number	:	517-783-5991

Provider Business Practice Location Address
First Line	:	205 N EAST AVE
Second Line	:	IMAGING DEPARTMENT
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-783-2612
Fax Number	:	517-783-5991

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/10/2017

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Directions to “ PIYUSH C PATEL M.D.” Practice Location

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