Healthcare Provider Details

I. General information

NPI: 1699744235
Provider Name (Legal Business Name): VIKRAM PATNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 MEMORIAL DR STE 280
BELLEVILLE IL
62226-5372
US

IV. Provider business mailing address

4550 MEMORIAL DR STE 280
BELLEVILLE IL
62226-5372
US

V. Phone/Fax

Practice location:
  • Phone: 618-767-3235
  • Fax: 618-433-6470
Mailing address:
  • Phone: 618-767-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2001019986
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036128894
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2001019986
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2001019986
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.128894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: