Healthcare Provider Details

I. General information

NPI: 1699018317
Provider Name (Legal Business Name): BIRJU PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 GREEN BAY RD
KENILWORTH IL
60043-1001
US

IV. Provider business mailing address

444 GREEN BAY RD
KENILWORTH IL
60043-1001
US

V. Phone/Fax

Practice location:
  • Phone: 847-853-0234
  • Fax: 847-853-0230
Mailing address:
  • Phone: 847-853-0234
  • Fax: 847-853-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036141220
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.141220
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: