Provider Demographics
NPI:1174520761
Name:PATEL, SHAILESH S (MD)
Entity type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:S
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 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:STE 506
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4816
Mailing Address - Country:US
Mailing Address - Phone:818-843-5864
Mailing Address - Fax:818-843-5860
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:STE 506
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4816
Practice Address - Country:US
Practice Address - Phone:818-843-5864
Practice Address - Fax:818-843-5860
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42502207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A425020Medicaid
CAW18631Medicare ID - Type Unspecified
CA00A425020Medicaid