Provider Demographics
NPI:1427498732
Name:PATEL, NIKETA A (DO)
Entity type:Individual
Prefix:
First Name:NIKETA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W FULLERTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:773-782-2800
Mailing Address - Fax:773-782-5042
Practice Address - Street 1:3600 W. FULLERTON AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647
Practice Address - Country:US
Practice Address - Phone:773-782-2800
Practice Address - Fax:773-782-5042
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062694207Q00000X
IL036139912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine