Basic Information
| Provider Information | |||||||||
| NPI: | 1174616197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NEETABEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 2313 E HILL RD | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484395059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109536400 | ||||||||
| FaxNumber: | 8109536477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 11/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301083183 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 4301083183 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4675577 | 05 | MI | MEDICAID | 18019 | 01 | MI | MCARE | OTHER | 01006280 | 01 | MI | HEALTHPLUS GHP | OTHER | 4963492 | 05 | MI | MEDICAID | 5751458 | 01 | MI | FIRST HEALTH | OTHER | 1023512 | 01 | MI | MHA HAN | OTHER | 080D410020 | 01 | MI | BCBSM BCN COMM CHOICE | OTHER |