Healthcare Provider Details

I. General information

NPI: 1386969426
Provider Name (Legal Business Name): PINAKI NALIN PATEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DAKOTA ST STE A
CRYSTAL LAKE IL
60012-3744
US

IV. Provider business mailing address

650 DAKOTA ST STE A
CRYSTAL LAKE IL
60012-3744
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-6000
  • Fax: 815-356-1104
Mailing address:
  • Phone: 815-455-6000
  • Fax: 815-356-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.127754
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: