Healthcare Provider Details

I. General information

NPI: 1053639336
Provider Name (Legal Business Name): DR. PRATIK KAMAL DALAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N MCCLINTOCK DR STE 3
CHANDLER AZ
85226-3766
US

IV. Provider business mailing address

755 E MCDOWELL RD FL 4
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3800
  • Fax: 480-821-3806
Mailing address:
  • Phone: 602-521-3090
  • Fax: 602-521-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number57973
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301111504
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number57973
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: