Basic Information
Provider Information
NPI: 1023364593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: SATYAM
MiddleName: LAKSHMANBHAI
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherLastNameType:  
Mailing Information
Address1: 1115 SE 164TH AVE DEPT 358
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986838004
CountryCode: US
TelephoneNumber: 3607291253
FaxNumber: 3607293185
Practice Location
Address1: 3377 RIVERBEND DR
Address2:  
City: SPRINGFIELD
State: OR
PostalCode: 974778803
CountryCode: US
TelephoneNumber: 5412226389
FaxNumber: 5412226385
Other Information
ProviderEnumerationDate: 08/01/2012
LastUpdateDate: 09/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD171518ORN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X4301100692MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X18113NVN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XMD171518ORY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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