Champak Patel, MD is a
Legal Medicine physician based in Braselton, Georgia. Champak Patel is licensed to practice in Georgia (license number 059888) and his current practice location is 5196 Hwy 53, Braselton, Georgia. He can be reached at his office (for appointments etc.) via phone at
(706) 824-9929.
NPI number for Champak Patel is 1073585782 and his current mailing address is 455 Beaver Ruin Rd, Lilburn, Georgia. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1073585782.
Physician's Profile
| Full Name | Champak Patel |
|---|
| Gender | Male |
|---|
| Speciality | Legal Medicine |
|---|
| Location | 5196 Hwy 53, Braselton, Georgia |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1073585782
- Provider Enumeration Date: 02/06/2006
- Last Update Date: 06/12/2008
Medical Identifiers
Medical identifiers for Champak Patel such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1073585782 | NPI | - | NPPES |
| 000411428001 | Other | NY | BLUE SHIELD |
| 00525411 | Medicaid | NY | |
| 75786IM | Other | NY | GHI |
| 11136 | Other | NY | MVP |
| 141618275 | Other | NY | TAX ID |
| 349351 | Other | NY | EMPIRE |
| 554972145A | Medicaid | GA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207RP1001X | Internal Medicine - Pulmonary Disease | 123503 (New York) | Secondary |
| 173000000X | Legal Medicine | 059888 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Champak Patel is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Champak Patel, MD
455 Beaver Ruin Rd,
Lilburn, GA 30047
Ph: (770) 923-7778 | Champak Patel, MD
5196 Hwy 53,
Braselton, GA 30517
Ph: (706) 824-9929 |
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