Provider Demographics
NPI:1902247604
Name:PATEL, SPANDAN VIDYUT (MD)
Entity Type:Individual
Prefix:DR
First Name:SPANDAN
Middle Name:VIDYUT
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5613
Mailing Address - Country:US
Mailing Address - Phone:702-476-4900
Mailing Address - Fax:702-476-4949
Practice Address - Street 1:6040 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5613
Practice Address - Country:US
Practice Address - Phone:702-476-4900
Practice Address - Fax:702-476-4949
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086727A207RC0200X
NV20474207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1902247604Medicaid
NV20474OtherNV MEDICAL LICENSE