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General NPI Number Information
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NPI Number | 1578078754
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Entity Type | Organization
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Legal Business Name | INNOVATIVE GERIATRICS LLC
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Dates
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Enumeration Date | 12/09/2017
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 301 MADISON ST STE 310
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City | JOLIET
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State | IL
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Zip | 60435-6686
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Country | US
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Telephone | 815-773-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 BELLA CT
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City | LISLE
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State | IL
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Zip | 60532-1696
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Country | US
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Telephone | 206-437-2948
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. YAQUTA PATNI
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Credential | MD
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Telephone | 206-437-2948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 036106333
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License Number State | IL
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