Provider Demographics
NPI:1174616197
Name:PATEL, NEETABEN R (MD)
Entity type:Individual
Prefix:DR
First Name:NEETABEN
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:2313 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5059
Practice Address - Country:US
Practice Address - Phone:810-953-6400
Practice Address - Fax:810-953-6477
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083183207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675577Medicaid
MI18019OtherMCARE
MI01006280OtherHEALTHPLUS GHP
MI4963492Medicaid
MI5751458OtherFIRST HEALTH
MI1023512OtherMHA HAN
MI080D410020OtherBCBSM BCN COMM CHOICE
MI18019OtherMCARE
MI5751458OtherFIRST HEALTH
MI1023512OtherMHA HAN