Provider Demographics
NPI:1619766789
Name:EAST VALLEY KIDNEY SPECIALIST PLLC HEALTH CARE
Entity type:Organization
Organization Name:EAST VALLEY KIDNEY SPECIALIST PLLC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:MALLANAGOUDA
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-309-8994
Mailing Address - Street 1:2040 S ALMA SCHOOL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 S STAPLEY DR STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6676
Practice Address - Country:US
Practice Address - Phone:602-525-5674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty