=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265798763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SULAY PANKAJ PATEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2012
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 ROSALIND REDFERN GROVER PKWY STE 240
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-221-3600
-----------------------------------------------------
Fax | 432-221-5981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4214 ANDREWS HWY STE 240
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79703-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-221-4243
-----------------------------------------------------
Fax | 432-221-5981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 73778
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | R7048
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------