Provider Demographics
NPI:1912931601
Name:PATEL, SUNDEEP SHASHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNDEEP
Middle Name:SHASHI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18301 N 79TH AVE
Mailing Address - Street 2:SUITE C135
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8463
Mailing Address - Country:US
Mailing Address - Phone:602-633-2247
Mailing Address - Fax:602-633-2347
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:SUITE C135
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:602-633-2247
Practice Address - Fax:602-633-2347
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ31155208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ777162005Medicaid
AZH86033Medicare UPIN