Provider Demographics
NPI:1184624181
Name:PATEL, ISHVARLAL (MD)
Entity type:Individual
Prefix:DR
First Name:ISHVARLAL
Middle Name:
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 1:124 S KYRENE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4721
Mailing Address - Country:US
Mailing Address - Phone:480-753-5490
Mailing Address - Fax:480-598-9364
Practice Address - Street 1:124 S KYRENE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4721
Practice Address - Country:US
Practice Address - Phone:480-753-5490
Practice Address - Fax:480-598-9364
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24577208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452748Medicaid
AZ452748Medicaid
AZ67195Medicare ID - Type Unspecified