Provider Demographics
NPI:1902987613
Name:PATEL, PRAKASH T (MD)
Entity Type:Individual
Prefix:MR
First Name:PRAKASH
Middle Name:T
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PRAKASHCHANDRA
Other - Middle Name:T
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:315 N 3RD AVE
Mailing Address - Street 2:# 306
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-332-1815
Mailing Address - Fax:626-966-9685
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:# 306
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-332-1815
Practice Address - Fax:626-966-9685
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA034471207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344710Medicaid
A27490Medicare UPIN
CA00A344710Medicaid