Healthcare Provider Details

I. General information

NPI: 1548572670
Provider Name (Legal Business Name): PAYAL DILIP PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S MICHIGAN AVE
CHICAGO IL
60605
US

IV. Provider business mailing address

1411 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

V. Phone/Fax

Practice location:
  • Phone: 312-454-2710
  • Fax: 312-563-2201
Mailing address:
  • Phone: 312-454-2710
  • Fax: 312-563-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036-132204
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-132204
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036-132204
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: