Provider Demographics
NPI:1578506465
Name:PATEL, PRADIPKUMAR K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADIPKUMAR
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:602-978-5005
Mailing Address - Fax:602-978-1115
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:602
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:602-978-5005
Practice Address - Fax:602-978-1115
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23394OtherARIZONA LICENSE
AZG23514Medicare UPIN