Provider Demographics
NPI:1881989820
Name:PATEL, RAXITKUMAR BHUPENDRAKUMAR (MD,)
Entity type:Individual
Prefix:
First Name:RAXITKUMAR
Middle Name:BHUPENDRAKUMAR
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 1:4540 E BASELINE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4617
Mailing Address - Country:US
Mailing Address - Phone:480-306-6405
Mailing Address - Fax:
Practice Address - Street 1:4540 E BASELINE RD STE 115
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4617
Practice Address - Country:US
Practice Address - Phone:480-306-6405
Practice Address - Fax:480-361-6108
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT198887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine