MEDICARE: PRIYANKA PATEL PC

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	019.028949	IL

General Provider Information

NPI Number	:	1558652057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIYANKA PATEL PC

Provider Business Mailing Address
First Line	:	211 E OHIO ST
Second Line	:	APT 1719
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E OHIO ST
Second Line	:	APT 1719
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	630-605-1589
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	PRIYANKA PATEL
Credential	:
Telephone Number	:	630-605-1589

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	04/11/2013

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