Provider Demographics
NPI:1629004569
Name:PATEL, SANJAY G (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:G
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 SANFORD PKWY
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2700
Practice Address - Country:US
Practice Address - Phone:218-683-2725
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34259207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN279082300Medicaid
MN907825OtherAMERICA'S PPO/ARAZ #
MN142043OtherUCARE #
MNHP 20443OtherHEALTHPARTNERS #
MN17749Medicaid
MN1M783PAOtherMNBS #
MN0402535OtherMEDICA #
MN5180OtherNDBS #
MNDA9021015706OtherPREFERRED ONE #
MNMN100017OtherLHS/BANNERHEALTH #
MN110064873Medicare ID - Type UnspecifiedRR MEDICARE #
MNDA9021015706OtherPREFERRED ONE #
MN119001819Medicare ID - Type UnspecifiedMN MEDICARE #
MN110011633Medicare PIN