Healthcare Provider Details

I. General information

NPI: 1629598578
Provider Name (Legal Business Name): AXI R PATEL MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 24TH ST STE 124
ROCK ISLAND IL
61201-5394
US

IV. Provider business mailing address

2570 24TH ST STE 124
ROCK ISLAND IL
61201-5394
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-3670
  • Fax:
Mailing address:
  • Phone: 309-779-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-152717
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036.152717
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-152717
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: