Healthcare Provider Details

I. General information

NPI: 1134627201
Provider Name (Legal Business Name): RESHA PATEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 FEEHANVILLE DR STE 200
MOUNT PROSPECT IL
60056-6036
US

IV. Provider business mailing address

1660 FEEHANVILLE DR STE 200
MOUNT PROSPECT IL
60056-6036
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-3185
  • Fax: 847-823-3318
Mailing address:
  • Phone: 847-823-3185
  • Fax: 847-823-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002418
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277002418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: