Healthcare Provider Details

I. General information

NPI: 1730076779
Provider Name (Legal Business Name): PRACHIBEN PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E 75TH ST
CHICAGO IL
60649-3603
US

IV. Provider business mailing address

3001 S KING DR APT 606
CHICAGO IL
60616-3176
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.086760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: