Healthcare Provider Details

I. General information

NPI: 1144767898
Provider Name (Legal Business Name): ASHISH RAVINDRA PATIL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ASHISH PATIL MD, PHD

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1962
US

IV. Provider business mailing address

1910 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1962
US

V. Phone/Fax

Practice location:
  • Phone: 786-449-0557
  • Fax:
Mailing address:
  • Phone: 520-887-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number68793
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number68793
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number321536
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number23-368
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberS-24-331
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number321536
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number68793
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 9
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number321536
License Number StateNY
# 10
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberA187591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: