Provider Demographics
NPI:1316159544
Name:PATEL-BOOLANI, DIPIKA (MD)
Entity type:Individual
Prefix:
First Name:DIPIKA
Middle Name:
Last Name:PATEL-BOOLANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4330 WORNALL RD
Mailing Address - Street 2:SUITE 40
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3201
Mailing Address - Country:US
Mailing Address - Phone:816-531-0930
Mailing Address - Fax:
Practice Address - Street 1:2375 E CAMELBACK RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3493
Practice Address - Country:US
Practice Address - Phone:602-551-8052
Practice Address - Fax:602-428-7025
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011025940207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCDR.0004076OtherSTATE LICENSE
MO2011025940OtherSTATE LICENSE