Provider Demographics
NPI:1316110893
Name:ROHIDAS T PATIL MD SC
Entity type:Organization
Organization Name:ROHIDAS T PATIL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-423-6500
Mailing Address - Street 1:1770 E LAKE SHORE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3832
Mailing Address - Country:US
Mailing Address - Phone:217-423-6500
Mailing Address - Fax:217-423-6536
Practice Address - Street 1:1770 E LAKE SHORE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3832
Practice Address - Country:US
Practice Address - Phone:217-423-6500
Practice Address - Fax:217-423-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0528812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052881Medicaid
IL036052881Medicaid