Provider Demographics
NPI:1316941248
Name:PATEL, SHANTILAL D (MD)
Entity type:Individual
Prefix:
First Name:SHANTILAL
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHANTILAL
Other - Middle Name:D
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25500 N. NORTERRA PARKWAY
Mailing Address - Street 2:BLDG. B
Mailing Address - City:PHOENIZ
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:623-815-2699
Practice Address - Street 1:13041 N. DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351
Practice Address - Country:US
Practice Address - Phone:623-977-7201
Practice Address - Fax:623-876-2318
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102048Medicare PIN
AZG69224Medicare UPIN