Provider Demographics
NPI:1891805792
Name:PATEL, HARIKRISHNA P (MD)
Entity type:Individual
Prefix:DR
First Name:HARIKRISHNA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:707 N LOGAN AVE
Mailing Address - Street 2:DANVILLE POLYCLINIC, LTD.
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-442-0400
Mailing Address - Fax:217-442-7410
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:DANVILLE POLYCLINIC, LTD.
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-442-0400
Practice Address - Fax:217-442-7410
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036072790207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C49056Medicare UPIN
IL753101Medicare PIN
IL753100Medicare PIN