Provider Demographics
NPI:1992735526
Name:PATEL, BHARAT K (SC)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:SC
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 191
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960
Mailing Address - Country:US
Mailing Address - Phone:618-524-2182
Mailing Address - Fax:618-524-2451
Practice Address - Street 1:12 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-524-2182
Practice Address - Fax:618-524-2451
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D93905Medicare UPIN
ILK50451Medicare PIN