Provider Demographics
NPI:1962408625
Name:PATEL, HASMUKH V (MD)
Entity type:Individual
Prefix:DR
First Name:HASMUKH
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3856
Mailing Address - Country:US
Mailing Address - Phone:708-788-0707
Mailing Address - Fax:630-887-9176
Practice Address - Street 1:236 CHAUCER CT
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5407
Practice Address - Country:US
Practice Address - Phone:708-788-0707
Practice Address - Fax:630-887-9176
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048033Medicaid
IL487770Medicare ID - Type Unspecified