Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 45755 | AZ |
NPI | 1811153604 |
---|---|
Provider Name | Amit Manu Patel |
First Address | Scottsdale, AZ 85260 |
Second Address | Scottsdale, AZ 85260-6742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
726532 | (05) | AZ |