Provider Demographics
NPI:1174748628
Name:PARKLAND CLINIC-MUNI H PATEL MD SC
Entity type:Organization
Organization Name:PARKLAND CLINIC-MUNI H PATEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-771-2088
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:STE 850
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-771-2088
Mailing Address - Fax:414-771-6308
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:STE 850
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-771-2088
Practice Address - Fax:414-771-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI554859OtherDEAN HEALTHCARE
WI15-66305OtherUNITED HEALTHCARE
WI221695OtherVALUEOPTIONS PROVIDER
WI394723651003OtherBLUE CROSS BLUE SHIELD
WI394509835002OtherBLUE CROSS BLUE SHIELD
WI930564044001OtherBLUE CROSS BLUE SHIELD
WI106502324002OtherBLUE CROSS BLUE SHIELD
WI30241700Medicaid
WI394509835002OtherBLUE CROSS BLUE SHIELD
WI221695OtherVALUEOPTIONS PROVIDER