MEDICARE: SHANTILAL D PATEL MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	26577	AZ

General Provider Information

NPI Number	:	1649460882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANTILAL D PATEL MD PLLC

Provider Business Mailing Address
First Line	:	13000 N 103RD AVE
Second Line	:	STE 79
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-815-2424
Fax Number	:	623-815-2699

Provider Business Practice Location Address
First Line	:	13000 N 103RD AVE
Second Line	:	STE 79
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-815-2424
Fax Number	:	623-815-2699

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	SHANTILAL D PATEL
Credential	:	MD
Telephone Number	:	623-815-2424

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	06/28/2010

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