Provider Demographics
NPI:1386748432
Name:SHASHIKANT AND KOKILA PATEL MD SC
Entity type:Organization
Organization Name:SHASHIKANT AND KOKILA PATEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHASHIKANT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-428-3262
Mailing Address - Street 1:14 PENTWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-428-3262
Mailing Address - Fax:866-591-1665
Practice Address - Street 1:434 E NORTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074
Practice Address - Country:US
Practice Address - Phone:847-358-5624
Practice Address - Fax:847-358-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058117207Q00000X
IL036050325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty