Healthcare Provider Details

I. General information

NPI: 1437168671
Provider Name (Legal Business Name): RAKESH PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 235
ALLEN TX
75013-6135
US

IV. Provider business mailing address

1850 GATEWAY DR
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-6042
  • Fax:
Mailing address:
  • Phone: 815-758-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-107106
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT1512
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: