Provider Demographics
NPI:1861451601
Name:PATIL, ASHWINIKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWINIKUMAR
Middle Name:
Last Name:PATIL
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 1:15021 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3215
Mailing Address - Country:US
Mailing Address - Phone:623-476-7880
Mailing Address - Fax:623-476-7890
Practice Address - Street 1:15021 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3215
Practice Address - Country:US
Practice Address - Phone:623-476-7880
Practice Address - Fax:623-476-7890
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ793639Medicaid
AZH89743Medicare UPIN
AZZ104830Medicare PIN
AZ793639Medicaid