Healthcare Provider Details

I. General information

NPI: 1285880898
Provider Name (Legal Business Name): RACHANA MUKESH PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RUSH 1653 W. CONGRESS PARKWAY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

RUSH 1653 W. CONGRESS PARKWAY
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125055219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: