Healthcare Provider Details

I. General information

NPI: 1902257462
Provider Name (Legal Business Name): JALPA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/06/2022
Certification Date: 05/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W ASPERA BLVD
GLENDALE AZ
85308-7947
US

IV. Provider business mailing address

16001 W 9 MILE RD 4TH FLOOR FISHER CENTER-DEPARTMENT OF MEDICAL EDUCATION
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 623-248-2100
  • Fax:
Mailing address:
  • Phone: 248-849-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number65728
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301109857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: