Provider Demographics
NPI:1962445528
Name:PATEL, SANJAY C
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6756 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5298
Mailing Address - Country:US
Mailing Address - Phone:219-805-4244
Mailing Address - Fax:219-513-8941
Practice Address - Street 1:9008 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2501
Practice Address - Country:US
Practice Address - Phone:219-513-8923
Practice Address - Fax:219-513-8941
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060936207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200810170Medicaid
INI 42122Medicare UPIN
IN499500AAAAMedicare PIN