Healthcare Provider Details

I. General information

NPI: 1033642251
Provider Name (Legal Business Name): AMITABEN PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 E DEVON AVE STE 333
DES PLAINES IL
60018
US

IV. Provider business mailing address

2250 E DEVON AVE STE 333
DES PLAINES IL
60018-4532
US

V. Phone/Fax

Practice location:
  • Phone: 224-803-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: