Provider Demographics
NPI:1225024318
Name:PATEL, RAJUL I (MD)
Entity Type:Individual
Prefix:
First Name:RAJUL
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52886
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072
Mailing Address - Country:US
Mailing Address - Phone:602-298-7777
Mailing Address - Fax:623-930-6060
Practice Address - Street 1:5859 W TALAVI BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1869
Practice Address - Country:US
Practice Address - Phone:602-298-7777
Practice Address - Fax:623-930-6060
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21576207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21576OtherAZ MEDICAL LICENSE
AZ136475Medicaid
AZZ71661Medicare PIN