Healthcare Provider Details

I. General information

NPI: 1982149209
Provider Name (Legal Business Name): YESHA PATEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 W MONROE ST
CHICAGO IL
60603-4901
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 800-323-8622
  • Fax: 224-225-0379
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015269
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: