Provider Demographics
NPI:1972834976
Name:PATEL, DAKSHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:DAKSHA
Middle Name:
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 1:1363 N LOS ALAMOS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4227
Mailing Address - Country:US
Mailing Address - Phone:480-981-8650
Mailing Address - Fax:480-981-1563
Practice Address - Street 1:6828 E BROWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3761
Practice Address - Country:US
Practice Address - Phone:480-981-8650
Practice Address - Fax:480-981-1563
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H26742Medicare UPIN