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General NPI Number Information
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NPI Number | 1255412094
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Entity Type | Individual
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Provider Name | JEETENDRA B PATEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 619 E MASON ST STE 4P57
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1034
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Country | US
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Telephone | 217-788-0706
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Fax | 217-525-2535
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Provider Business Mailing Address
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Address Line | 619 E MASON ST STE 4P57
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1034
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Country | US
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Telephone | 217-788-0706
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Fax | 217-525-2535
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 61845
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101281934
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036173952
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 0101281934
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 61845
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036173952
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License Number State | IL
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