Healthcare Provider Details

I. General information

NPI: 1538565551
Provider Name (Legal Business Name): OJAS SAMIR PARIKH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N DEARBORN ST STE 100
CHICAGO IL
60654-4618
US

IV. Provider business mailing address

635 N DEARBORN ST STE 100
CHICAGO IL
60654-4618
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-2273
  • Fax: 312-694-2129
Mailing address:
  • Phone: 312-694-2273
  • Fax: 312-694-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085007409
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007230
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085007409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: