Provider Demographics
NPI:1679696892
Name:MIRACLE MEDICAL CLINIC
Entity type:Organization
Organization Name:MIRACLE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PINAKIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-0236
Mailing Address - Street 1:1170 BLALOCK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7421
Mailing Address - Country:US
Mailing Address - Phone:713-464-0236
Mailing Address - Fax:713-463-8282
Practice Address - Street 1:1170 BLALOCK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7421
Practice Address - Country:US
Practice Address - Phone:713-464-0236
Practice Address - Fax:713-463-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2727207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00388TOtherBLUECROSS BLUESHIELD
TXDC2363OtherRAILROAD MEDICARE
TX168655201Medicaid
TX00388TOtherBLUECROSS BLUESHIELD
TX168655201Medicaid