Provider Demographics
NPI:1154386506
Name:PATEL, KALPESH M (MD)
Entity type:Individual
Prefix:DR
First Name:KALPESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12624 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5448
Mailing Address - Country:US
Mailing Address - Phone:815-577-6446
Mailing Address - Fax:815-577-6331
Practice Address - Street 1:12624 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5448
Practice Address - Country:US
Practice Address - Phone:815-577-6446
Practice Address - Fax:815-577-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036108691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932322OtherBCBS
ILP00258693OtherRR MEDICARE
IL036108691Medicaid
IL14D1045386OtherCLIA
IL036108691Medicaid
ILK18514Medicare PIN