Healthcare Provider Details

I. General information

NPI: 1649660903
Provider Name (Legal Business Name): RAKESHKUMAR PATEL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEMPSTEAD PL
JOLIET IL
60433-1745
US

IV. Provider business mailing address

101 HEMPSTEAD PL STE 1D
JOLIET IL
60433-1749
US

V. Phone/Fax

Practice location:
  • Phone: 815-485-4610
  • Fax:
Mailing address:
  • Phone: 815-485-4610
  • Fax: 815-485-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002583
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: