MEDICARE: MILI PATEL

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DS042270	PA

General Provider Information

NPI Number	:	1912468059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILI PATEL

Provider Business Mailing Address
First Line	:	350 N CLARK ST STE 600
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 N CLARK ST STE 600
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4782
Country	:	US
Telephone Number	:	212-111-1212
Fax Number	:

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	06/24/2019

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Directions to “ MILI PATEL ” Practice Location

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