MEDICARE: SHILAM SHIRISH PATEL DMD

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	122300000X	Dentist	019.031190	IL

General Provider Information

NPI Number	:	1376066860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHILAM SHIRISH PATEL DMD

Provider Business Mailing Address
First Line	:	700 E OGDEN AVE STE 302
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5554
Country	:	US
Telephone Number	:	630-789-3903
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E OGDEN AVE STE 302
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5554
Country	:	US
Telephone Number	:	630-789-3903
Fax Number	:

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	05/27/2026

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