1548798721 NPI number — DR. KISHAN VINOD PATEL DMD

Table of content: DR. KISHAN VINOD PATEL DMD (NPI 1548798721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548798721 NPI number — DR. KISHAN VINOD PATEL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
KISHAN
Provider Middle Name:
VINOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548798721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 N CLARK ST STE 600
Provider Second Line Business Mailing Address:
C/O KOS SERVICES, ATTN: HR
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 SACK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-466-6800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  DN1857592 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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