Healthcare Provider Details

I. General information

NPI: 1134243454
Provider Name (Legal Business Name): SUJAY L PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

2505 ANTHEM VILLAGE DR SUITE E 134
HENDERSON NV
89052-5505
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5000
  • Fax:
Mailing address:
  • Phone: 702-401-4202
  • Fax: 702-485-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1457
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: