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NPI Code Detail

MEDICARE: PHALGUNI PATEL D.D.S

MEDICARE: PHALGUNI PATEL D.D.S
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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1356551154
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHALGUNI PATEL D.D.S
Provider Business Mailing Address
First Line : 856 W NELSON ST
Second Line : APT # 803
City : CHICAGO
State : IL
Zip : 60657-5152
Country : US
Telephone Number : 773-477-7078
Fax Number :
Provider Business Practice Location Address
First Line : 811 W WELLINGTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5123
Country : US
Telephone Number : 773-871-1461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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