1174748628 NPI number — PARKLAND CLINIC-MUNI H PATEL MD SC

Table of content: (NPI 1174748628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174748628 NPI number — PARKLAND CLINIC-MUNI H PATEL MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKLAND CLINIC-MUNI H PATEL MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174748628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 N MAYFAIR RD
Provider Second Line Business Mailing Address:
STE 850
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-1309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-771-2088
Provider Business Mailing Address Fax Number:
414-771-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 N MAYFAIR RD
Provider Second Line Business Practice Location Address:
STE 850
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-771-2088
Provider Business Practice Location Address Fax Number:
414-771-6308
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MUNI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-771-2088

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 554859 . This is a "DEAN HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 15-66305 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 221695 . This is a "VALUEOPTIONS PROVIDER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 394723651003 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 394509835002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 930564044001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 106502324002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 30241700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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