Organization
FAYETTE CO PHYSICIAN ORGANIZATION DBA FAMILY PRACTICE WVMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SURESH PATEL MD (MANAGING MEMBER)
(765) 827-1903
Entity
Organization
Contact information
Practice address
1473 E STATE ROAD 44, SUITE 2, CONNERSVILLE, IN 47331-8292
(765) 825-8686
(765) 827-1918
Mailing address
PO BOX 779, CONNERSVILLE, IN 47331-0779
(765) 825-8686
(765) 827-1918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/03/2006
Last updated
03/25/2008
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