Healthcare Provider Details

I. General information

NPI: 1073289799
Provider Name (Legal Business Name): SHIVANI PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

IV. Provider business mailing address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8143
  • Fax: 312-695-4075
Mailing address:
  • Phone: 312-695-8143
  • Fax: 312-695-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: