Healthcare Provider Details

I. General information

NPI: 1194848325
Provider Name (Legal Business Name): SHAMIM PATEL, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1206B
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1206B
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-908-2928
  • Fax: 312-944-1480
Mailing address:
  • Phone: 312-908-2928
  • Fax: 312-944-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: IVY BRANTLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 312-908-2928