=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316159544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIPIKA PATEL-BOOLANI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2375 E CAMELBACK RD STE 600
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-3493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-551-8052
-----------------------------------------------------
Fax | 602-428-7025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4330 WORNALL RD SUITE 40
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-531-0930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 2011025940
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------