MEDICARE: DR. SAMIR MAHENDRA 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	019028698	IL
2	122300000X	Dentist	018001772	IL

General Provider Information

NPI Number	:	1922310234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR MAHENDRA PATEL D.M.D.

Provider Business Mailing Address
First Line	:	939 W MADISON ST
Second Line	:	#201
City	:	CHICAGO
State	:	IL
Zip	:	60607-2638
Country	:	US
Telephone Number	:	217-390-8219
Fax Number	:

Provider Business Practice Location Address
First Line	:	939 W MADISON ST
Second Line	:	#201
City	:	CHICAGO
State	:	IL
Zip	:	60607-2638
Country	:	US
Telephone Number	:	217-390-8219
Fax Number	:

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/13/2015

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