Healthcare Provider Details

I. General information

NPI: 1154459246
Provider Name (Legal Business Name): SANGINI DINESH PATEL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N SHERIDAN RD SUITE #210
CHICAGO IL
60657
US

IV. Provider business mailing address

711 W GORDON TR #320
CHICAGO IL
60613
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-0046
  • Fax:
Mailing address:
  • Phone: 602-684-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: