Healthcare Provider Details

I. General information

NPI: 1770799660
Provider Name (Legal Business Name): CHANDRAHAS B. PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 W BELL RD SUITE 100
GLENDALE AZ
85308-3781
US

IV. Provider business mailing address

6120 W BELL RD STE 130
GLENDALE AZ
85308-3782
US

V. Phone/Fax

Practice location:
  • Phone: 623-512-4326
  • Fax: 623-584-6732
Mailing address:
  • Phone: 623-239-4624
  • Fax: 623-594-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number41460
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number41460
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: