Healthcare Provider Details

I. General information

NPI: 1487203659
Provider Name (Legal Business Name): CHAULA PATEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 07/21/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W. TAYLOR ST.
CHICAGO IL
60612
US

IV. Provider business mailing address

1818 W TAYLOR ST
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021581
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041422558
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: