Basic Information
Provider Information
NPI: 1619385820
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: JAIMIE
MiddleName: E.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 ACKERMAN RD STE 2120
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432021559
CountryCode: US
TelephoneNumber: 6142937499
FaxNumber:  
Practice Location
Address1: 410 W 10TH AVE
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432101240
CountryCode: US
TelephoneNumber: 6142937499
FaxNumber: 6143662360
Other Information
ProviderEnumerationDate: 07/31/2014
LastUpdateDate: 07/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X2014029425MON Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X2016013289MON Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X4301112802MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X4301112802MIN Allopathic & Osteopathic PhysiciansHospitalist 
208M00000X35.142250OHY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home