Provider Demographics
NPI:1740558022
Name:PATEL, KRUNAL (MD)
Entity Type:Individual
Prefix:
First Name:KRUNAL
Middle Name:
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 1:5605 W EUGIE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1273
Mailing Address - Country:US
Mailing Address - Phone:480-756-6000
Mailing Address - Fax:855-636-8770
Practice Address - Street 1:5605 W EUGIE AVE STE 111
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:480-756-6000
Practice Address - Fax:855-636-8770
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57633207VM0101X
NJ25MA09930300207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ548181Medicaid