Healthcare Provider Details

I. General information

NPI: 1205983160
Provider Name (Legal Business Name): SACHIN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1100
CHICAGO IL
60611-2954
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1100
CHICAGO IL
60611-2954
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5060
  • Fax: 312-695-5010
Mailing address:
  • Phone: 312-695-5060
  • Fax: 312-695-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD0000044399
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD44399
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036158298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: