Healthcare Provider Details

I. General information

NPI: 1770110884
Provider Name (Legal Business Name): RICKY PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR
HARVEY IL
60426-3558
US

IV. Provider business mailing address

71 W 156TH ST STE 110
HARVEY IL
60426-4267
US

V. Phone/Fax

Practice location:
  • Phone: 855-826-3878
  • Fax:
Mailing address:
  • Phone: 855-826-3878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number125075967
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125075967
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: