Provider Demographics
NPI:1821298134
Name:PATEL, SHAMIL SURENDRA (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:SHAMIL
Middle Name:SURENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6677 W THUNDERBIRD RD STE F101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3723
Mailing Address - Country:US
Mailing Address - Phone:623-878-3939
Mailing Address - Fax:623-878-5567
Practice Address - Street 1:6677 W THUNDERBIRD RD STE F101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3723
Practice Address - Country:US
Practice Address - Phone:623-878-3939
Practice Address - Fax:623-878-5567
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN6568207W00000X
AZ44312207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology