Healthcare Provider Details

I. General information

NPI: 1346945185
Provider Name (Legal Business Name): RAVIKUMAR PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 ROSE AVE
LYONS IL
60534-1053
US

IV. Provider business mailing address

4136 ROSE AVE
LYONS IL
60534-1053
US

V. Phone/Fax

Practice location:
  • Phone: 708-307-1744
  • Fax:
Mailing address:
  • Phone: 708-307-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036177970
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: