Healthcare Provider Details

I. General information

NPI: 1063538072
Provider Name (Legal Business Name): SCOTTSDALE SURGICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14256 N NORTHSIGHT BLVD STE 120
SCOTTSDALE AZ
85260-3954
US

IV. Provider business mailing address

14256 N NORTHSIGHT BLVD SUITE 120
SCOTTSDALE AZ
85260-3953
US

V. Phone/Fax

Practice location:
  • Phone: 480-212-1185
  • Fax: 480-212-1186
Mailing address:
  • Phone: 480-212-1185
  • Fax: 480-212-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KUMASH R PATEL
Title or Position: MEMBER
Credential: MD
Phone: 480-212-1185