Provider Demographics
NPI:1801150727
Name:PATEL, HIRAL R
Entity type:Individual
Prefix:
First Name:HIRAL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-1631
Mailing Address - Country:US
Mailing Address - Phone:616-227-0555
Mailing Address - Fax:517-647-1100
Practice Address - Street 1:1447 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-1631
Practice Address - Country:US
Practice Address - Phone:616-227-0555
Practice Address - Fax:517-647-1100
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI6301018316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program