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NPI Code Detail

MEDICARE: SANDEEP MALLANAGOUDA PATIL M.D

MEDICARE: SANDEEP MALLANAGOUDA PATIL M.D
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
1207RN0300XNephrology Physician50371AZ
2207R00000XInternal Medicine Physician202074LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912153222
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDEEP MALLANAGOUDA PATIL M.D
Provider Business Mailing Address
First Line : 2040 S ALMA SCHOOL RD STE 1
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-7076
Country : US
Telephone Number : 480-290-1822
Fax Number : 949-864-3908
Provider Business Practice Location Address
First Line : 1910 S STAPLEY DR STE 120
Second Line :
City : MESA
State : AZ
Zip : 85204-6676
Country : US
Telephone Number : 602-525-5674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2008
Last Update Date : 11/03/2025

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Directions to “ SANDEEP MALLANAGOUDA PATIL M.D” Practice Location

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