Healthcare Provider Details

I. General information

NPI: 1871584946
Provider Name (Legal Business Name): GAURANG P PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST SUITE 3200
DECATUR IL
62526-4163
US

IV. Provider business mailing address

2300 N EDWARD ST GSBLL
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3660
  • Fax: 217-876-3665
Mailing address:
  • Phone: 217-876-2857
  • Fax: 217-876-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036075836
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: