MEDICARE: PHALGUNI PATEL DDS 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	019.026270	IL

General Provider Information

NPI Number	:	1659668119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHALGUNI PATEL DDS PC

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	:
Fax Number	:

Provider Business Practice Location 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	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PHALGUNI PATEL
Credential	:
Telephone Number	:	773-477-7078

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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