Healthcare Provider Details

I. General information

NPI: 1548298425
Provider Name (Legal Business Name): KUMASH PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD SUITE E-456
GLENDALE AZ
85306-4641
US

IV. Provider business mailing address

5757 W THUNDERBIRD RD SUITE E-456
GLENDALE AZ
85306-4641
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-4570
  • Fax: 602-865-4575
Mailing address:
  • Phone: 602-865-4570
  • Fax: 602-865-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35096
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35096
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35096
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number35096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: