Basic Information
| Provider Information | |||||||||
| NPI: | 1134294853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | AMRITBHAI | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 IROQUOIS ROAD | ||||||||
| Address2: | |||||||||
| City: | WILMETTE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600911232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309521412 | ||||||||
| FaxNumber: | 7735254022 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 N SHERIDAN ROAD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606576117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309521412 | ||||||||
| FaxNumber: | 7735254022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 036058256 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0021609903 | 01 | IL | BCBS | OTHER | 036058256 | 05 | IL | MEDICAID |