Basic Information
| Provider Information | |||||||||
| NPI: | 1497899009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | DHAVAL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 698 FEATHERSTONE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153983277 | ||||||||
| FaxNumber: | 8159861448 | ||||||||
| Practice Location | |||||||||
| Address1: | 698 FEATHERSTONE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153983277 | ||||||||
| FaxNumber: | 8159861448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 49831 | MN | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 208200000X | 336.078808 | IL | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | F400199319 | 01 | IL | MEDICARE INDIVIDUAL | OTHER | IL6310 | 01 | IL | MEDICARE GROUP | OTHER | 473965000 | 05 | MN | MEDICAID | 036117242 | 05 | IL | MEDICAID | 35294600 | 05 | WI | MEDICAID | ENROLLED | 05 | IA | MEDICAID |