Healthcare Provider Details

I. General information

NPI: 1083697692
Provider Name (Legal Business Name): ANKIT M PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 GLENWOOD AVE
JOLIET IL
60435-5574
US

IV. Provider business mailing address

2201 GLENWOOD AVE
JOLIET IL
60435-5574
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-1191
  • Fax: 815-725-2048
Mailing address:
  • Phone: 815-725-1191
  • Fax: 815-725-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: