Healthcare Provider Details

I. General information

NPI: 1578499430
Provider Name (Legal Business Name): SIDDHI J PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17465 KEDZIE AVE
HAZEL CREST IL
60429-1632
US

IV. Provider business mailing address

17465 KEDZIE AVE
HAZEL CREST IL
60429-1632
US

V. Phone/Fax

Practice location:
  • Phone: 708-887-7329
  • Fax: 708-907-0771
Mailing address:
  • Phone: 708-887-7329
  • Fax: 708-907-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: