Provider Demographics
NPI:1053401760
Name:PATEL, GIRISH A (MD)
Entity type:Individual
Prefix:DR
First Name:GIRISH
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:GIRISH
Other - Middle Name:A
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3435 S ALAMEDA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1728
Mailing Address - Country:US
Mailing Address - Phone:361-855-9494
Mailing Address - Fax:361-855-5010
Practice Address - Street 1:3435 S ALAMEDA ST
Practice Address - Street 2:SUITE D
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1728
Practice Address - Country:US
Practice Address - Phone:361-855-9494
Practice Address - Fax:361-855-5010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126249502Medicaid
TX126249505Medicaid
TX00MJ20OtherBCBS
TX760092548OtherTAX ID NUMBER
TX00MJ20OtherBCBS