Provider Demographics
NPI:1932103868
Name:PATEL, UPENDRA C (MD)
Entity Type:Individual
Prefix:
First Name:UPENDRA
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UPENDRA
Other - Middle Name:C
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13000 N 103RD AVE
Mailing Address - Street 2:STE 79
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3060
Mailing Address - Country:US
Mailing Address - Phone:623-815-2424
Mailing Address - Fax:623-815-2699
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:STE 79
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3060
Practice Address - Country:US
Practice Address - Phone:623-815-2424
Practice Address - Fax:623-815-2699
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102511Medicare PIN
AZE60567Medicare UPIN