Provider Demographics
NPI:1194763375
Name:PATEL, JAGDISH (MD)
Entity type:Individual
Prefix:DR
First Name:JAGDISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 GETTLER ST STE 455
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2381
Mailing Address - Country:US
Mailing Address - Phone:219-864-1100
Mailing Address - Fax:219-864-1118
Practice Address - Street 1:2150 GETTLER ST STE 455
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311
Practice Address - Country:US
Practice Address - Phone:219-864-1100
Practice Address - Fax:219-864-1118
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056772207RC0000X
IN01029938A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060070689OtherRR MEDICARE
IN000000091333OtherANTHEM
IN100322640Medicaid
IN06070691OtherRR MEDICARE
IN000000091333OtherANTHEM
IL060070689OtherRR MEDICARE
ILL96074Medicare ID - Type Unspecified
IL060027093Medicare PIN
IL060070689OtherRR MEDICARE
IN100322640Medicaid