Healthcare Provider Details

I. General information

NPI: 1679499875
Provider Name (Legal Business Name): MADHUSUDAN PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

IV. Provider business mailing address

448 W GRANT PL APT 1
CHICAGO IL
60614-0666
US

V. Phone/Fax

Practice location:
  • Phone: 773-626-4300
  • Fax:
Mailing address:
  • Phone: 260-557-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125.089033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: