MEDICARE: DR. KAMLESH MAHENDRA PATEL BDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	021002036	IL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	019024966	IL

General Provider Information

NPI Number	:	1255417911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMLESH MAHENDRA PATEL BDS

Provider Business Mailing Address
First Line	:	1628 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-327-9500
Fax Number	:	773-327-3080

Provider Business Practice Location Address
First Line	:	1628 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-327-9500
Fax Number	:	773-327-3080

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	09/03/2009

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