Basic Information
Provider Information
NPI: 1568436673
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: RAKESHKUMAR
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2196 E WILLIAMS FIELD RD
Address2: #116
City: GILBERT
State: AZ
PostalCode: 852950754
CountryCode: US
TelephoneNumber: 4802371395
FaxNumber: 6022184076
Practice Location
Address1: 2196 E WILLIAMS FIELD RD
Address2: #116
City: GILBERT
State: AZ
PostalCode: 852950754
CountryCode: US
TelephoneNumber: 4802371395
FaxNumber: 6022184076
Other Information
ProviderEnumerationDate: 02/15/2006
LastUpdateDate: 08/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X26824AZY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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