Healthcare Provider Details

I. General information

NPI: 1801020938
Provider Name (Legal Business Name): PRITI PATIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 S 80TH AVE
PALOS HEIGHTS IL
60463-1256
US

IV. Provider business mailing address

270 W LOOP ROAD
WHEATON IL
60189
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4000
  • Fax: 608-263-0682
Mailing address:
  • Phone: 630-653-8464
  • Fax: 630-653-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.138209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: