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General NPI Number Information
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NPI Number | 1497876098
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Entity Type | Individual
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Provider Name | MANISHA PATEL PA
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 850 N MILWAUKEE AVE
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City | VERNON HILLS
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State | IL
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Zip | 60061-1553
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Country | US
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Telephone | 847-563-9663
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Fax | 847-563-9662
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Provider Business Mailing Address
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Address Line | 6400 HOFFMAN TER
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City | MORTON GROVE
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State | IL
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Zip | 60053-1410
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Country | US
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Telephone | 847-452-8028
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085001467
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License Number State | IL
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