Healthcare Provider Details

I. General information

NPI: 1922369669
Provider Name (Legal Business Name): NEERAJ M PATEL MD, MPH, MBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611
US

IV. Provider business mailing address

225 EAST CHICAGO AVENUE, BOX 69 DIVISION OF ORTHOPAEDIC SURGERY
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6521
  • Fax:
Mailing address:
  • Phone: 312-227-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMT212652
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number036.146855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: