Provider Demographics
NPI:1447227319
Name:PATEL, SANJAY J (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-434-6412
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-434-6412
Practice Address - Fax:260-434-6395
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01054837A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349970Medicaid
OH2279065Medicaid
INP00800706OtherRAILROAD MEDICARE
IN000000204995OtherANTHEM
INH50611Medicare UPIN
IN260690WWMedicare PIN
INH50611Medicare UPIN