Healthcare Provider Details

I. General information

NPI: 1124438643
Provider Name (Legal Business Name): GAYATRI PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8624
  • Fax: 312-695-4141
Mailing address:
  • Phone: 312-695-8624
  • Fax: 312-695-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036142750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: