Healthcare Provider Details

I. General information

NPI: 1790961977
Provider Name (Legal Business Name): KARE4KIDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E LAKE SHORE DR SUITE 330
DECATUR IL
62521-3824
US

IV. Provider business mailing address

1900 E LAKE SHORE DR SUITE 330
DECATUR IL
62521-3824
US

V. Phone/Fax

Practice location:
  • Phone: 217-423-2889
  • Fax:
Mailing address:
  • Phone: 217-423-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042619185
License Number StateIL

VIII. Authorized Official

Name: DR. SAMIR A PATEL
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 217-423-2889