Healthcare Provider Details

I. General information

NPI: 1811779960
Provider Name (Legal Business Name): MAUSAM PATEL APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 2060
CHICAGO IL
60611-2994
US

IV. Provider business mailing address

259 E ERIE ST STE 2060
CHICAGO IL
60611-2994
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-6022
  • Fax: 312-695-5672
Mailing address:
  • Phone: 312-695-6022
  • Fax: 312-695-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0034821
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031726
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: