Healthcare Provider Details

I. General information

NPI: 1588407472
Provider Name (Legal Business Name): JANVI MANISH PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W. CONGRESS PARKWAY 1042 KELLOGG
CHICAGO IL
60612
US

IV. Provider business mailing address

1717 W. CONGRESS PARKWAY 1042 KELLOGG
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5269
  • Fax: 312-942-5271
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.085291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: