Basic Information
Provider Information
NPI: 1467415794
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: VIJAYKANT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4351 SIR JOHN AVE
Address2:  
City: NORTH ROYALTON
State: OH
PostalCode: 441334126
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 12300 MCCRACKEN RD
Address2:  
City: GARFIELD HEIGHTS
State: OH
PostalCode: 441252914
CountryCode: US
TelephoneNumber: 2165810500
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PE0004X35041841POHY Allopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services

No ID Information.


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