Healthcare Provider Details

I. General information

NPI: 1942324298
Provider Name (Legal Business Name): CHIRAG PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 W 159TH ST
MARKHAM IL
60428-4047
US

IV. Provider business mailing address

422 RIDGEMOOR DR
WILLOWBROOK IL
60527-5419
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-3318
  • Fax: 708-390-3739
Mailing address:
  • Phone: 312-622-6314
  • Fax: 708-390-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036117215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: