Provider Demographics
NPI:1821042540
Name:ISHAN N VKC, INC.
Entity Type:Organization
Organization Name:ISHAN N VKC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-977-1331
Mailing Address - Street 1:5150 N 16TH ST
Mailing Address - Street 2:STE B232
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3990
Mailing Address - Country:US
Mailing Address - Phone:623-977-1331
Mailing Address - Fax:623-977-1449
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:H101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3689
Practice Address - Country:US
Practice Address - Phone:623-977-1331
Practice Address - Fax:623-977-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ329105Medicaid
AZ329105Medicaid
AZZ76674Medicare PIN