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General NPI Number Information
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NPI Number | 1619434602
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Entity Type | Individual
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Provider Name | ROSHNI K PATEL PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 773-702-1865
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Fax | 737-702-6809
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Provider Business Mailing Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 773-702-1865
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Fax | 773-702-6809
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9112021
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.006935
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License Number State | IL
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