Healthcare Provider Details

I. General information

NPI: 1770845596
Provider Name (Legal Business Name): UTSAHI R PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 MOON LAKE BLVD SUITE 206
HOFFMAN ESTATES IL
60169-5029
US

IV. Provider business mailing address

1786 MOON LAKE BLVD SUITE 206
HOFFMAN ESTATES IL
60169-5029
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-4300
  • Fax:
Mailing address:
  • Phone: 847-882-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.138022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: