Provider Demographics
NPI:1356333660
Name:PATEL, PRANAV (MD)
Entity Type:Individual
Prefix:
First Name:PRANAV
Middle Name:
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 1:19777 N 76TH ST APT 2283
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3823
Mailing Address - Country:US
Mailing Address - Phone:602-910-3774
Mailing Address - Fax:
Practice Address - Street 1:4722 N 24TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4800
Practice Address - Country:US
Practice Address - Phone:602-546-0676
Practice Address - Fax:602-546-5012
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2217902080N0001X
NV118702080N0001X
AZ372832080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI34082Medicare UPIN
NY130SK1Medicare ID - Type Unspecified