Provider Demographics
NPI:1245511344
Name:PATEL, SIPA PRABHA (DO)
Entity type:Individual
Prefix:DR
First Name:SIPA
Middle Name:PRABHA
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1263 LAKE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3564
Mailing Address - Country:US
Mailing Address - Phone:719-776-3300
Mailing Address - Fax:719-776-3329
Practice Address - Street 1:1263 LAKE PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3564
Practice Address - Country:US
Practice Address - Phone:719-776-3300
Practice Address - Fax:719-776-3329
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09379800207Q00000X
CODR.0055610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine