Healthcare Provider Details

I. General information

NPI: 1174083414
Provider Name (Legal Business Name): RAVI DIPAK PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 665
PARK RIDGE IL
60068-1168
US

IV. Provider business mailing address

5045 CAROL ST
SKOKIE IL
60077-2202
US

V. Phone/Fax

Practice location:
  • Phone: 847-825-1590
  • Fax:
Mailing address:
  • Phone: 847-852-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036.180050
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125074871
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: