MEDICARE: RENUKA 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	2085R0202X	Diagnostic Radiology Physician	4301044604	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300129519	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301044604	OTHER	MI	STATE OF MICHIGAN MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3003802611	OTHER	MI	BCBS OF MI

General Provider Information

NPI Number	:	1831190461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENUKA M 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	:	08/04/2005
Last Update Date	:	11/06/2015

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Directions to “ RENUKA M PATEL M.D.” Practice Location

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