Healthcare Provider Details

I. General information

NPI: 1790703916
Provider Name (Legal Business Name): PARAG VITHAL PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST SUITE 525, PARKSIDE BLDG.
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

1875 DEMPSTER ST SUITE B01, PARKSIDE BLDG.
PARK RIDGE IL
60068-1186
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-3600
  • Fax: 847-318-2949
Mailing address:
  • Phone: 847-723-7763
  • Fax: 847-723-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036089356
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: