Provider Demographics
NPI:1366475048
Name:PATNI, DEEPALI PHATAK (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPALI
Middle Name:PHATAK
Last Name:PATNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPALI
Other - Middle Name:GANESH
Other - Last Name:PHATAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:1200 MCKINNEY ST
Practice Address - Street 2:SUITE 473
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77010-2016
Practice Address - Country:US
Practice Address - Phone:713-442-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8163207V00000X
NY242864207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4438OtherBCBS
TX160296302Medicaid
TX160296303Medicaid
TX8L14110Medicare PIN
TXH90895Medicare UPIN
TX8L14113Medicare PIN
TX8A9785Medicare PIN
TX8L14110Medicare PIN