Healthcare Provider Details

I. General information

NPI: 1386748432
Provider Name (Legal Business Name): SHASHIKANT AND KOKILA PATEL MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 E NORTHWEST HIGHWAY
PALATINE IL
60074
US

IV. Provider business mailing address

14 PENTWATER DRIVE
SOUTH BARRINGTON IL
60010
US

V. Phone/Fax

Practice location:
  • Phone: 847-358-5624
  • Fax: 847-358-5624
Mailing address:
  • Phone: 847-428-3262
  • Fax: 866-591-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036058117
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036050325
License Number StateIL

VIII. Authorized Official

Name: MR. SHASHIKANT H PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 847-428-3262