Healthcare Provider Details

I. General information

NPI: 1619109154
Provider Name (Legal Business Name): JAYNA PATEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DAVIS ST STE 5767
EVANSTON IL
60201-5945
US

IV. Provider business mailing address

1101 DAVIS ST STE 5767
EVANSTON IL
60201-5945
US

V. Phone/Fax

Practice location:
  • Phone: 844-475-3379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number20067
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: