Provider Demographics
NPI:1023122249
Name:PATEL, SANDIP G (MD)
Entity type:Individual
Prefix:
First Name:SANDIP
Middle Name:G
Last Name:PATEL
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 1:26926 N 55TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7345
Mailing Address - Country:US
Mailing Address - Phone:623-249-5617
Mailing Address - Fax:623-398-6791
Practice Address - Street 1:26926 N 55TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-7345
Practice Address - Country:US
Practice Address - Phone:623-249-5617
Practice Address - Fax:623-398-6791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430823Medicaid