Healthcare Provider Details

I. General information

NPI: 1558055608
Provider Name (Legal Business Name): NILAY PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 N SOUTHPORT AVE
CHICAGO IL
60613-6889
US

IV. Provider business mailing address

7721 CROOKED COVE ST
KALAMAZOO MI
49009-4072
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-8989
  • Fax:
Mailing address:
  • Phone: 269-348-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019035293
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: