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General NPI Number Information
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NPI Number | 1720303563
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Entity Type | Organization
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Legal Business Name | PATEL MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 1620 E WILCOX DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2778
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Country | US
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Telephone | 520-459-0362
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Fax | 520-458-1585
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Provider Business Mailing Address
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Address Line | 1620 E WILCOX DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2778
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Country | US
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Telephone | 520-459-0362
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Fax | 520-458-1585
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. SANTSARAN CHANDUBHAI PATEL
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Credential | M.D.
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Telephone | 520-459-0362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23373
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License Number State | AZ
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