Healthcare Provider Details

I. General information

NPI: 1497899009
Provider Name (Legal Business Name): DHAVAL M PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 FEATHERSTONE RD
ROCKFORD IL
61107-6303
US

IV. Provider business mailing address

698 FEATHERSTONE RD
ROCKFORD IL
61107-6303
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-3277
  • Fax: 815-986-1448
Mailing address:
  • Phone: 815-398-3277
  • Fax: 815-986-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number49831
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number336.078808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: