Provider Demographics
NPI:1649460882
Name:SHANTILAL D PATEL MD PLLC
Entity type:Organization
Organization Name:SHANTILAL D PATEL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHANTILAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-815-2424
Mailing Address - Street 1:13000 N 103RD AVE
Mailing Address - Street 2:STE 79
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3024
Mailing Address - Country:US
Mailing Address - Phone:623-815-2424
Mailing Address - Fax:623-815-2699
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:STE 79
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3024
Practice Address - Country:US
Practice Address - Phone:623-815-2424
Practice Address - Fax:623-815-2699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANTILAL D PATEL MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102047Medicare PIN
AZG69224Medicare UPIN