Basic Information
| Provider Information | |||||||||
| NPI: | 1871889329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | AMIT | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27702 NETWORK PL | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606731277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088627674 | ||||||||
| FaxNumber: | 7088621781 | ||||||||
| Practice Location | |||||||||
| Address1: | 19550 GOVERNORS HWY | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | FLOSSMOOR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604222125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089578750 | ||||||||
| FaxNumber: | 7089578602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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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 | 390200000X | 125060430 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 036133822 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01953160 | 01 | IL | RRM | OTHER | 036133822 | 05 | IL | MEDICAID | F400436605 | 01 | IL | MEDICARE | OTHER |