Healthcare Provider Details

I. General information

NPI: 1205805553
Provider Name (Legal Business Name): BIREN G. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14674 W MOUNTAIN VIEW BLVD SUITE 210
SURPRISE AZ
85374-2706
US

IV. Provider business mailing address

14674 W MOUNTAIN VIEW BLVD SUITE 210
SURPRISE AZ
85374-2706
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-1400
  • Fax: 623-546-0745
Mailing address:
  • Phone: 623-546-1400
  • Fax: 623-546-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number26753
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: