Provider Demographics
NPI:1639301906
Name:PATEL, NISHA N (DO)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 CREEKTON DR UNIT 2503
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6428
Mailing Address - Country:US
Mailing Address - Phone:312-320-2247
Mailing Address - Fax:
Practice Address - Street 1:7010 CREEKTON DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6428
Practice Address - Country:US
Practice Address - Phone:312-320-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.056254.207R00000X
KY04232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine