Healthcare Provider Details

I. General information

NPI: 1952425118
Provider Name (Legal Business Name): URJEET A. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST #603
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

1726 W OHIO ST
CHICAGO IL
60622-6001
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-5139
  • Fax: 312-864-9751
Mailing address:
  • Phone: 312-666-5495
  • Fax: 312-864-9751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036-108987
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number036-108987
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: