Healthcare Provider Details

I. General information

NPI: 1649331158
Provider Name (Legal Business Name): SHIKA PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 W POLK ST
CHICAGO IL
60612-4352
US

IV. Provider business mailing address

635 N DEARBORN ST APT 1104
CHICAGO IL
60610-6742
US

V. Phone/Fax

Practice location:
  • Phone: 312-423-4200
  • Fax: 312-423-4372
Mailing address:
  • Phone: 312-787-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: