Healthcare Provider Details

I. General information

NPI: 1992010516
Provider Name (Legal Business Name): YAYATI S. PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 95TH ST STE 105
NAPERVILLE IL
60564-7802
US

IV. Provider business mailing address

2007 95TH ST STE 105
NAPERVILLE IL
60564-7802
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6920
  • Fax: 630-646-6925
Mailing address:
  • Phone: 630-646-6920
  • Fax: 630-646-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036131839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: