Provider Demographics
NPI:1730150848
Name:PATEL, SUNIL H (MD)
Entity type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:H
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:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-1196
Mailing Address - Country:US
Mailing Address - Phone:209-833-0525
Mailing Address - Fax:209-830-7361
Practice Address - Street 1:1470 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3459
Practice Address - Country:US
Practice Address - Phone:209-833-0525
Practice Address - Fax:209-830-7361
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A439570Medicaid
CA00A439570Medicaid
A29759Medicare UPIN