MEDICARE: DR. MANDAR A PATTEKAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1194775858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANDAR A PATTEKAR M.D.

Provider Business Mailing Address
First Line	:	411 HAMILTON BLVD
Second Line	:	SUITE 1824
City	:	PEORIA
State	:	IL
Zip	:	61602-1144
Country	:	US
Telephone Number	:	309-494-9320
Fax Number	:	309-494-9321

Provider Business Practice Location Address
First Line	:	5200 RELIABLE PARKWAY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	309-671-8748
Fax Number	:	309-671-8740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/09/2007

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