Basic Information
| Provider Information | |||||||||
| NPI: | 1801020938 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATIL | ||||||||
| FirstName: | PRITI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 W LOOP ROAD | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306538464 | ||||||||
| FaxNumber: | 6306538660 | ||||||||
| Practice Location | |||||||||
| Address1: | 12251 S 80TH AVE | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089234000 | ||||||||
| FaxNumber: | 6082630682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2009 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 036.138209 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.