Individual
MITA B PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4676 ADMIRALTY WAY # 301, MARINA DEL REY, CA 90292-6601
(310) 673-3945
(310) 673-0273
Mailing address
9200 W WISCONSIN AVE, DIVISION OF CARDIOLOGY, MILWAUKEE, WI 53226-3522
(414) 955-6777
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.054484
IL
207R00000X
Internal Medicine Physician
64496
WI
207RC0000X
Cardiovascular Disease Physician
Primary
A150310
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609032986
—
WI
Enumeration date
08/06/2008
Last updated
06/25/2020
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