MEDICARE: MADHUSUDAN F PATEL MD

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	207Q00000X	Family Medicine Physician	35-05-0098P	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35-05-0098P	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1881687101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHUSUDAN F PATEL MD

Provider Business Mailing Address
First Line	:	723 PHILLIPS AVE
Second Line	:	SUITE 201-A
City	:	TOLEDO
State	:	OH
Zip	:	43612-1300
Country	:	US
Telephone Number	:	419-476-2124
Fax Number	:	419-476-3882

Provider Business Practice Location Address
First Line	:	723 PHILLIPS AVE
Second Line	:	SUITE 201-A
City	:	TOLEDO
State	:	OH
Zip	:	43612-1300
Country	:	US
Telephone Number	:	419-476-2124
Fax Number	:	419-476-3882

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/16/2009

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