Healthcare Provider Details

I. General information

NPI: 1386063782
Provider Name (Legal Business Name): KUSHAL R PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 09/29/2026
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

IV. Provider business mailing address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-4066
  • Fax: 815-971-9299
Mailing address:
  • Phone: 815-971-4066
  • Fax: 815-971-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036150632
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64513-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA150247
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036150632
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: