Provider Demographics
NPI:1073310017
Name:PATEL, KUNTAL (PHARMD)
Entity type:Individual
Prefix:
First Name:KUNTAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6759 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2154
Mailing Address - Country:US
Mailing Address - Phone:847-977-2993
Mailing Address - Fax:
Practice Address - Street 1:6759 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2154
Practice Address - Country:US
Practice Address - Phone:847-977-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051298137OtherILLINOIS DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION