MEDICARE: DR. GAURAV A PATEL D.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	122300000X	Dentist	01924608	IL

General Provider Information

NPI Number	:	1417089194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAURAV A PATEL D.M.D

Provider Business Mailing Address
First Line	:	1000 GRAND CANYON PKWY
Second Line	:	SUITE 200
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60194-1705
Country	:	US
Telephone Number	:	847-885-8780
Fax Number	:	847-885-9818

Provider Business Practice Location Address
First Line	:	1000 GRAND CANYON PKWY
Second Line	:	SUITE 200
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60194-1705
Country	:	US
Telephone Number	:	847-885-8780
Fax Number	:	847-885-9818

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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