Healthcare Provider Details

I. General information

NPI: 1104245406
Provider Name (Legal Business Name): RAJ D PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 W OKLAHOMA AVE
MILWAUKEE WI
53215-4455
US

IV. Provider business mailing address

1918 GLENBRIDGE RD
BLOOMINGTON IL
61704-8708
US

V. Phone/Fax

Practice location:
  • Phone: 414-389-2797
  • Fax:
Mailing address:
  • Phone: 337-842-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036.143275
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberXX01248494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: