Healthcare Provider Details

I. General information

NPI: 1982522371
Provider Name (Legal Business Name): GERIATRIC SUPPORT MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 E CAREFREE HWY STE 131
CAVE CREEK AZ
85331-4745
US

IV. Provider business mailing address

4705 E CAREFREE HWY STE 131
CAVE CREEK AZ
85331-4745
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-4908
  • Fax:
Mailing address:
  • Phone: 714-698-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RAVI PATEL
Title or Position: PRESIDENT
Credential: DO
Phone: 714-698-4908