Provider Demographics
NPI:1811218670
Name:SANDIP PATEL MD PLC
Entity Type:Organization
Organization Name:SANDIP PATEL MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-249-5617
Mailing Address - Street 1:26926 N 55TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7345
Mailing Address - Country:US
Mailing Address - Phone:623-249-5617
Mailing Address - Fax:623-398-6791
Practice Address - Street 1:15021 W BELL RD
Practice Address - Street 2:STE. 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3916
Practice Address - Country:US
Practice Address - Phone:623-249-5617
Practice Address - Fax:623-398-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531690Medicaid
AZ531690Medicaid