Provider Demographics
NPI:1568550127
Name:PATEL, SANJAY R (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:R
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11030 N. TATUM BLVD
Mailing Address - Street 2:BLDG F, SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:602-889-9880
Mailing Address - Fax:480-304-9328
Practice Address - Street 1:11030 N. TATUM BLVD
Practice Address - Street 2:BLDG F, SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:602-889-9880
Practice Address - Fax:480-304-9328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80499225400000X
AZ40721208100000X
TXU6548208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87499Medicare UPIN