Provider Demographics
NPI:1992930689
Name:PATEL, RENUKA J (APN)
Entity type:Individual
Prefix:MRS
First Name:RENUKA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:808 E WOODFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4836
Mailing Address - Country:US
Mailing Address - Phone:847-605-0030
Mailing Address - Fax:847-637-0737
Practice Address - Street 1:804 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4776
Practice Address - Country:US
Practice Address - Phone:847-605-9500
Practice Address - Fax:847-605-8700
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL277.000326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILIL1648007Medicare PIN