1447268487 NPI number — TEJESH N PATEL MD

Table of content: TEJESH N PATEL MD (NPI 1447268487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447268487 NPI number — TEJESH N PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
TEJESH
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1447268487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 E. HUEBBE PARKWAY
Provider Second Line Business Mailing Address:
BELOIT HEALTH SYSTEM INC.
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-364-2200
Provider Business Mailing Address Fax Number:
608-363-7395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 OGDEN AVE
Provider Second Line Business Practice Location Address:
CLINTON CLINIC
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53525-9007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-676-2206
Provider Business Practice Location Address Fax Number:
608-676-4029
Provider Enumeration Date:
08/04/2006

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: 207Q00000X , with the licence number:  43301020 , 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: 1447268487 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12908 . This is a "DEAN HEALTH PLAN HMO" identifier . This identifiers is of the category "OTHER".




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