Provider Demographics
NPI:1467563544
Name:PRAVIN T. PATEL, M.D., P.C.
Entity Type:Organization
Organization Name:PRAVIN T. PATEL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-972-8794
Mailing Address - Street 1:13000 N 103RD AVE
Mailing Address - Street 2:79
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3024
Mailing Address - Country:US
Mailing Address - Phone:623-972-8794
Mailing Address - Fax:623-815-2699
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:79
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3024
Practice Address - Country:US
Practice Address - Phone:623-972-8794
Practice Address - Fax:623-815-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ551649Medicaid
AZZ111427Medicare PIN
AZ551649Medicaid