Healthcare Provider Details

I. General information

NPI: 1750409710
Provider Name (Legal Business Name): SAMEER PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

PEDIATRIC FACULTY FOUNDATION DEPARTMENT 4580
CAROL STREAM IL
60122-0001
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4667
  • Fax: 212-227-9709
Mailing address:
  • Phone: 312-227-7200
  • Fax: 312-227-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number036132020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: