Healthcare Provider Details

I. General information

NPI: 1326097585
Provider Name (Legal Business Name): VIJAY PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 E 93RD ST SUITE 340
CHICAGO IL
60617-3910
US

IV. Provider business mailing address

PO BOX 10428
MERRILLVILLE IN
46411-0428
US

V. Phone/Fax

Practice location:
  • Phone: 773-721-0322
  • Fax: 773-721-1471
Mailing address:
  • Phone: 219-681-2065
  • Fax: 219-681-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036060465
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: