Healthcare Provider Details

I. General information

NPI: 1265798763
Provider Name (Legal Business Name): SULAY PANKAJ PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROSALIND REDFERN GROVER PKWY STE 240
MIDLAND TX
79701
US

IV. Provider business mailing address

4214 ANDREWS HWY STE 240
MIDLAND TX
79703-4817
US

V. Phone/Fax

Practice location:
  • Phone: 432-221-3600
  • Fax: 432-221-5981
Mailing address:
  • Phone: 432-221-4243
  • Fax: 432-221-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number73778
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR7048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: