Provider Demographics
NPI:1447268487
Name:PATEL, TEJESH N (MD)
Entity type:Individual
Prefix:
First Name:TEJESH
Middle Name:N
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 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC.
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:307 OGDEN AVE
Practice Address - Street 2:CLINTON CLINIC
Practice Address - City:CLINTON
Practice Address - State:WI
Practice Address - Zip Code:53525-9007
Practice Address - Country:US
Practice Address - Phone:608-676-2206
Practice Address - Fax:608-676-4029
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43301020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1447268487Medicaid
12908OtherDEAN HEALTH PLAN HMO
WI1447268487Medicaid