Healthcare Provider Details

I. General information

NPI: 1386223543
Provider Name (Legal Business Name): SIVANGI PATEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 N BOSWORTH AVE UNIT 2
CHICAGO IL
60642
US

IV. Provider business mailing address

1542 N BOSWORTH AVE UNIT 2
CHICAGO IL
60642
US

V. Phone/Fax

Practice location:
  • Phone: 630-532-3752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-077792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: