Healthcare Provider Details

I. General information

NPI: 1790039725
Provider Name (Legal Business Name): PILSEN MEDICAL CLINIC & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 W HARRISON ST SUITE 247
HILLSIDE IL
60162
US

IV. Provider business mailing address

4415 W HARRISON ST SUITE 247
HILLSIDE IL
60162
US

V. Phone/Fax

Practice location:
  • Phone: 312-738-3355
  • Fax:
Mailing address:
  • Phone: 312-738-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PIUSHKUMAR PATEL
Title or Position: CEO
Credential: MD
Phone: 312-738-3355