Healthcare Provider Details

I. General information

NPI: 1114073095
Provider Name (Legal Business Name): UDIT VIJAY PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIKU PATEL D.O.

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 ESSINGTON RD
JOLIET IL
60435-4912
US

IV. Provider business mailing address

744 ESSINGTON RD
JOLIET IL
60435-4912
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-0700
  • Fax: 815-729-0707
Mailing address:
  • Phone: 815-729-0700
  • Fax: 815-729-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-116060
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: