Healthcare Provider Details

I. General information

NPI: 1801086087
Provider Name (Legal Business Name): KANDARP R PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD SUITE 478
PHOENIX AZ
85037-3328
US

IV. Provider business mailing address

9305 W THOMAS RD STE 478
PHOENIX AZ
85037-3375
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-8507
  • Fax: 623-236-8508
Mailing address:
  • Phone: 623-236-8507
  • Fax: 623-236-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number005243
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberCDR.0005159
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number13109-321
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: