| Connecticut Lifestyle Medicine | |
|
955 S Main St Middletown CT 06457-5153 | |
| (516) 993-2847 | |
| Not Available |
| Full Name | Connecticut Lifestyle Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 955 S Main St, Middletown, Connecticut |
| Authorized Official Name and Position | Dipak N Patel (PHYSICIAN) |
| Authorized Official Contact | 5169932847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Lifestyle Medicine 419 Scarborough Ln Middletown CT 06457-7551 Ph: (516) 993-2847 | Connecticut Lifestyle Medicine 955 S Main St Middletown CT 06457-5153 Ph: (516) 993-2847 |
| NPI Number | 1619527959 |
|---|---|
| Provider Enumeration Date | 09/18/2019 |
| Last Update Date | 09/18/2019 |
| Medicare PECOS PAC ID | 0941629448 |
|---|---|
| Medicare Enrollment ID | O20201002000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619527959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Dipak Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952568834 PECOS PAC ID: 7810041597 Enrollment ID: I20090814000091 |
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