Provider Demographics
NPI:1285647461
Name:PATEL, ATUL B (MD)
Entity Type:Individual
Prefix:MR
First Name:ATUL
Middle Name:B
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 1:20033 N 19TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4245
Mailing Address - Country:US
Mailing Address - Phone:623-516-8499
Mailing Address - Fax:623-516-8641
Practice Address - Street 1:20033 N 19TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4245
Practice Address - Country:US
Practice Address - Phone:623-516-8499
Practice Address - Fax:623-516-8641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22892208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72363Medicare UPIN
AZMD22892Medicare ID - Type Unspecified