Individual
DR. MAHADEV PATIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1068 CRESTHAVEN RD, SUITE 150, MEMPHIS, TN 38119-0800
(901) 682-6828
Mailing address
PO BOX 171181, MEMPHIS, TN 38187-1181
(901) 682-2872
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD10770
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00016666
MS MEDICAID
MS
01
—
050052439
RR MEDICARE
—
01
—
173743001
ARK MEDICAID
AR
01
—
2007800
BLUE CROSS
TN
05
—
3165232
—
TN
Enumeration date
07/08/2006
Last updated
10/26/2016
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