Healthcare Provider Details

I. General information

NPI: 1144661083
Provider Name (Legal Business Name): SAMIT PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 LONGLEAF DR
ELK GROVE CA
95758-1322
US

IV. Provider business mailing address

PO BOX 588500
ELK GROVE CA
95758-8500
US

V. Phone/Fax

Practice location:
  • Phone: 916-691-6065
  • Fax:
Mailing address:
  • Phone: 916-691-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125064027
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC172437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: