Healthcare Provider Details

I. General information

NPI: 1639130271
Provider Name (Legal Business Name): SPORTS AND OCCUPATIONAL HEALTH CONSULTANTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MAIN ST SUITE L
ST CHARLES IL
60174-1775
US

IV. Provider business mailing address

2000 W MAIN ST SUITE L
ST CHARLES IL
60174-1775
US

V. Phone/Fax

Practice location:
  • Phone: 630-803-6019
  • Fax: 866-266-0504
Mailing address:
  • Phone: 630-803-6019
  • Fax: 866-266-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: VIMAL N PATEL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 630-803-6021