Provider Demographics
NPI:1447255252
Name:PATEL, ATULKUMAR RAMANBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:ATULKUMAR
Middle Name:RAMANBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 S HENDERSON BLVD, STE 2A
Mailing Address - Street 2:STE 2A
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3672
Mailing Address - Country:US
Mailing Address - Phone:903-984-2002
Mailing Address - Fax:
Practice Address - Street 1:2019 S HENDERSON BLVD
Practice Address - Street 2:STE 2A
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3672
Practice Address - Country:US
Practice Address - Phone:903-984-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ3721OtherLICENCE
TXBP3334783OtherDEA, FEDRAL
TXJ3721OtherLICENCE
TXBP3334783OtherDEA, FEDRAL
TX00K44UMedicare ID - Type Unspecified