Individual
DR. DIVYESH GAJU PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 E LINCOLNWAY, VALPARAISO, IN 46383-5803
(219) 464-4891
(219) 464-1873
Mailing address
825 E LINCOLNWAY, VALPARAISO, IN 46383-5803
(219) 464-4891
(219) 464-1873
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01063311A
IN
2085R0202X
Diagnostic Radiology Physician
4301085194
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00413508
RR MEDICARE
IN
Enumeration date
02/06/2007
Last updated
11/13/2007
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