Healthcare Provider Details

I. General information

NPI: 1568303683
Provider Name (Legal Business Name): KANCHI PATEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARTIN AVE
NAPERVILLE IL
60540-6536
US

IV. Provider business mailing address

1419 DANBURY LN
DES PLAINES IL
60018-1264
US

V. Phone/Fax

Practice location:
  • Phone: 630-848-1200
  • Fax: 630-848-1208
Mailing address:
  • Phone: 630-848-1200
  • Fax: 630-848-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041.516054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: