Healthcare Provider Details

I. General information

NPI: 1659802718
Provider Name (Legal Business Name): GEE PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GHANSHYAM B PATEL

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 LORRAINE PL
SCHAUMBURG IL
60173-6178
US

IV. Provider business mailing address

1347 LORRAINE PL
SCHAUMBURG IL
60173-6178
US

V. Phone/Fax

Practice location:
  • Phone: 847-612-3447
  • Fax:
Mailing address:
  • Phone: 847-612-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number212.000181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: