Provider Demographics
NPI:1831209030
Name:PATEL, MAHENDRA J (MD)
Entity type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:J
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 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:4401 HARRISON BOULEVARD
Practice Address - Street 2:MCKAY DEE HOSPITAL
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83-170033-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT53261OtherHEALTHY U
UTQM0000075886OtherALTIUS
UT8597445OtherWORKERS COMP
UT36350OtherDESERET MUTUAL
UT37811OtherPEHP
AZ825929Medicaid
WY108046600Medicaid
UT1502954OtherUMWA
ID804075000Medicaid
UTPRA02021OtherMOLINA
UT870545614AP2OtherEDUCATORS MUTUAL
NV002087044Medicaid
UT2090168OtherUNITED HEALTHCARE
UT107006045101OtherIHC
UTD20246Medicare UPIN
UT005532741Medicare ID - Type Unspecified
ID804075000Medicaid