Healthcare Provider Details

I. General information

NPI: 1497375687
Provider Name (Legal Business Name): VIVEK B PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date: 03/25/2024
Reactivation Date: 04/02/2024

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2501
US

IV. Provider business mailing address

41 UNIVERSITY DR STE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3129
  • Fax: 217-326-1550
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD483527
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036173071
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: