Healthcare Provider Details

I. General information

NPI: 1023089307
Provider Name (Legal Business Name): VIKRAM B PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 COMMERCE DR
ALGONQUIN IL
60102-5916
US

IV. Provider business mailing address

PO BOX 1053
BEDFORD PARK IL
60499-1053
US

V. Phone/Fax

Practice location:
  • Phone: 847-426-7516
  • Fax:
Mailing address:
  • Phone: 727-823-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number36099069
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierL81069
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE
# 2
Identifier35641715
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHILED OF IL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: