Individual
RENUKA M PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 N EAST AVE, IMAGING DEPARTMENT, JACKSON, MI 49201-1753
(517) 783-2612
(517) 783-5991
Mailing address
2800 SPRING ARBOR RD STE 102, PO BOX 905, JACKSON, MI 49203-3895
(517) 783-2612
(517) 783-5991
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301044604
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300129519
RAILROAD MEDICARE
—
01
—
3003802611
BCBS OF MI
MI
01
—
4301044604
STATE OF MICHIGAN MEDICAL LICENSE
MI
05
—
4383939
—
MI
Enumeration date
08/04/2005
Last updated
11/06/2015
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