1811218670 NPI number — SANDIP PATEL MD PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811218670 NPI number — SANDIP PATEL MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDIP PATEL MD PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811218670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26926 N 55TH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85083-7345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-249-5617
Provider Business Mailing Address Fax Number:
623-398-6791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15021 W BELL RD
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-249-5617
Provider Business Practice Location Address Fax Number:
623-398-6791
Provider Enumeration Date:
06/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SANDIP
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
623-249-5617

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  41789 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 531690 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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