Provider Demographics
NPI:1952690042
Name:PATEL, PUNAM V (MD)
Entity Type:Individual
Prefix:
First Name:PUNAM
Middle Name:V
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 S CIMARRON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2157
Mailing Address - Country:US
Mailing Address - Phone:862-324-4668
Mailing Address - Fax:702-835-0676
Practice Address - Street 1:7220 S CIMARRON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2157
Practice Address - Country:US
Practice Address - Phone:702-384-1160
Practice Address - Fax:702-835-0676
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6779208600000X
390200000X
NV20749208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1952690042Medicaid