Provider Demographics
NPI:1225228471
Name:UPENDRA C PATEL MD PLLC
Entity Type:Organization
Organization Name:UPENDRA C PATEL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:UPENDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-815-2424
Mailing Address - Street 1:13000 N 103RD AVE
Mailing Address - Street 2:STE 79
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3024
Mailing Address - Country:US
Mailing Address - Phone:623-815-2424
Mailing Address - Fax:623-815-2699
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:STE 79
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3024
Practice Address - Country:US
Practice Address - Phone:623-815-2424
Practice Address - Fax:623-815-2699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE MEDICAL MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102510Medicare PIN
AZE60567Medicare UPIN