1366475048 NPI number — DR. DEEPALI PHATAK PATNI M.D.

Table of content: ALEXUS ALDACO AA (NPI 1306712401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366475048 NPI number — DR. DEEPALI PHATAK PATNI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATNI
Provider First Name:
DEEPALI
Provider Middle Name:
PHATAK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHATAK
Provider Other First Name:
DEEPALI
Provider Other Middle Name:
GANESH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366475048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11511 SHADOW CREEK PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-7298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-442-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 MCKINNEY ST
Provider Second Line Business Practice Location Address:
SUITE 473
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77010-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-442-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  L8163 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 160296303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8A4438 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 160296302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".