Healthcare Provider Details

I. General information

NPI: 1780611467
Provider Name (Legal Business Name): VIPUL M PATEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 INDIANAPOLIS BLVD
WHITING IN
46394-1948
US

IV. Provider business mailing address

10506 CAPISTRANO LN
ORLAND PARK IL
60467-8245
US

V. Phone/Fax

Practice location:
  • Phone: 219-659-9000
  • Fax: 219-659-0944
Mailing address:
  • Phone: 219-659-9000
  • Fax: 219-659-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000921A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: