Provider Demographics
NPI:1215968854
Name:PATODIA, NIRMAL (MD)
Entity type:Individual
Prefix:DR
First Name:NIRMAL
Middle Name:
Last Name:PATODIA
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 1:1111 SUPERIOR STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-338-9388
Mailing Address - Fax:708-388-9389
Practice Address - Street 1:1111 SUPERIOR STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-338-9388
Practice Address - Fax:708-388-9389
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053904207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053904Medicaid
21609006OtherBCBS
060068384OtherRRM
21609006OtherBCBS
IL646400Medicare ID - Type Unspecified