Provider Demographics
NPI:1588981302
Name:PATEL, MAULIK CHANDRAKANT (PT,MS,DPT)
Entity type:Individual
Prefix:
First Name:MAULIK
Middle Name:CHANDRAKANT
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT,MS,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 W INDUSTRIAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1608
Mailing Address - Country:US
Mailing Address - Phone:847-243-6041
Mailing Address - Fax:
Practice Address - Street 1:188 W INDUSTRIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1608
Practice Address - Country:US
Practice Address - Phone:847-243-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014864OtherSTATE OF MI