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General NPI Number Information
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NPI Number | 1891969903
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Entity Type | Organization
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Legal Business Name | WISE HEALTH PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 1127 N. OAKLEY AVE 5TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60622-3507
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Country | US
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Telephone | 773-989-9868
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Fax | 773-989-9824
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Provider Business Mailing Address
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Address Line | 1127 N. OAKLEY AVE 5TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60622-3507
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Country | US
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Telephone | 773-989-9868
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Fax | 773-989-9824
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHEPHALI A PATEL
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Credential | M.D.
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Telephone | 847-322-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036091776
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License Number State | IL
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