Healthcare Provider Details

I. General information

NPI: 1992202097
Provider Name (Legal Business Name): DAVEL KIRAN PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST RM E592B
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1143
US

V. Phone/Fax

Practice location:
  • Phone: 312-609-0300
  • Fax: 847-723-4378
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.153487
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.153487
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: