Provider Demographics
NPI:1467400580
Name:PATEL, NILESH HARIBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:NILESH
Middle Name:HARIBHAI
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 1:13128 N 94TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4252
Mailing Address - Country:US
Mailing Address - Phone:623-259-5900
Mailing Address - Fax:630-933-2009
Practice Address - Street 1:13128 N 94TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4252
Practice Address - Country:US
Practice Address - Phone:623-259-5900
Practice Address - Fax:338-766-3364
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361060112085R0204X
AZ564422085R0204X
CAG0757622085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE GROUP
ILP00463387OtherMEDICARE RAILROAD
IL0935687403Medicaid
IL3625139096019701OtherCDH HFS GROUP PAYEE ID
IL3625139096019701OtherCDH HFS GROUP PAYEE ID
ILP00463387OtherMEDICARE RAILROAD