Provider Demographics
NPI:1194889691
Name:PATEL, MEETA JAIN (MD)
Entity type:Individual
Prefix:
First Name:MEETA
Middle Name:JAIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6264 EDGEBROOK LN E
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6994
Mailing Address - Country:US
Mailing Address - Phone:708-246-4627
Mailing Address - Fax:708-246-4627
Practice Address - Street 1:6264 EDGEBROOK LN E
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525-6994
Practice Address - Country:US
Practice Address - Phone:708-246-4627
Practice Address - Fax:708-246-4627
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112281208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112281Medicaid
I19122Medicare UPIN
201846Medicare ID - Type Unspecified