Provider Demographics
NPI:1063525202
Name:PATEL, BHAVESH K (MD)
Entity type:Individual
Prefix:
First Name:BHAVESH
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10100 FOREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-8234
Mailing Address - Country:US
Mailing Address - Phone:815-713-2742
Mailing Address - Fax:
Practice Address - Street 1:4211 N CICERO AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1652
Practice Address - Country:US
Practice Address - Phone:815-713-2742
Practice Address - Fax:815-282-8597
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-107252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107252Medicaid
ILL96179Medicare ID - Type Unspecified
ILL96178Medicare ID - Type Unspecified
IL036107252Medicaid