Individual
KAVITA SHANKER-PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3614 PROVIDENCE RD S STE 200, WAXHAW, NC 28173-6310
(704) 384-8640
(704) 384-8650
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036138106
IL
207Q00000X
Family Medicine Physician
125061830
IL
207Q00000X
Family Medicine Physician
Primary
2022-01815
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036138106
MEDICAID
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
F400250954
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
04/09/2012
Last updated
10/03/2022
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