Healthcare Provider Details

I. General information

NPI: 1932012663
Provider Name (Legal Business Name): PEAJAKTA VILAS PATIL MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 EAST HURON STREET
CHICAGO IL
60611
US

IV. Provider business mailing address

12229 NE 130TH WAY APT G204
KIRKLAND WA
98034-7355
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3494
  • Fax:
Mailing address:
  • Phone: 425-500-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: