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NPI Code Detail

MEDICARE: SHIVANI PATEL

MEDICARE: SHIVANI PATEL
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1336709740
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIVANI PATEL
Provider Business Mailing Address
First Line : 1250 S MICHIGAN AVE APT 1903
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3272
Country : US
Telephone Number : 408-728-1501
Fax Number :
Provider Business Practice Location Address
First Line : 4560 W 103RD ST STE 2
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-4870
Country : US
Telephone Number : 773-841-8180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 06/18/2019

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Directions to “ SHIVANI PATEL ” Practice Location

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