Healthcare Provider Details

I. General information

NPI: 1023245446
Provider Name (Legal Business Name): JAGRUTI PATEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W TOUHY AVE
CHICAGO IL
60646-1100
US

IV. Provider business mailing address

6201 W TOUHY AVE
CHICAGO IL
60646-1100
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-5166
  • Fax:
Mailing address:
  • Phone: 847-673-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number016005446
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: