Provider Demographics
NPI:1720303563
Name:PATEL MEDICAL CLINIC, PLLC
Entity Type:Organization
Organization Name:PATEL MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTSARAN
Authorized Official - Middle Name:CHANDUBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-459-0362
Mailing Address - Street 1:1620 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2778
Mailing Address - Country:US
Mailing Address - Phone:520-459-0362
Mailing Address - Fax:520-458-1585
Practice Address - Street 1:1620 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2778
Practice Address - Country:US
Practice Address - Phone:520-459-0362
Practice Address - Fax:520-458-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty