Provider Demographics
NPI:1265798763
Name:PATEL, SULAY PANKAJ
Entity type:Individual
Prefix:
First Name:SULAY
Middle Name:PANKAJ
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-221-4243
Mailing Address - Fax:432-221-5981
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY STE 240
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-221-3600
Practice Address - Fax:432-221-5981
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73778207RI0011X
TXR7048207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA073778OtherGEORGIA COMPOSITE MEDICAL BOARD
TXR7084OtherTEXAS MEDICAL BOARD