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General NPI Number Information
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NPI Number | 1699857615
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Entity Type | Individual
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Provider Name | KRISHAN I PATEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3810
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Country | US
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Telephone | 217-422-6100
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Fax | 217-422-7897
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Provider Business Mailing Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3810
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Country | US
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Telephone | 217-422-6100
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Fax | 217-422-7897
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 036-050324
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License Number State | IL
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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 | 036050324
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License Number State | IL
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