1174705164 NPI number — MANISH B PATEL M.D.

Table of content: MANISH B PATEL M.D. (NPI 1174705164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174705164 NPI number — MANISH B PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MANISH
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174705164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3655 W ANTHEM WAY
Provider Second Line Business Mailing Address:
SUITE A-109, PMB 313
Provider Business Mailing Address City Name:
ANTHEM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85086-0430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-505-4479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19829 N 27TH AVE
Provider Second Line Business Practice Location Address:
ATTN: INDEPENDENT HOSPITALISTS
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-406-3538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  43463 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 43463 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)