| Doctor Name: | KOMAL PATEL |
| NPI Number: | 1558758466 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 085.005429 |
| Business Practice Address: | 5520 Godfrey Rd Godfrey, IL - 620352741 |
| Business Phone Number: | 6184637800 |
| Business Fax Number: | |
| Mailing Address: | 1230 Blumeyer St Apt F, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631061681 |
| Phone Number: | 7345600756 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2015 |
| NPI Last Update Date: | 04/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085.005429 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |