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General NPI Number Information
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NPI Number | 1952670911
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Entity Type | Organization
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Legal Business Name | DR PATEL SC
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 6090 STRATHMOOR DR STE 4
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City | ROCKFORD
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State | IL
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Zip | 61107-5200
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Country | US
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Telephone | 847-321-9465
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Fax |
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Provider Business Mailing Address
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Address Line | 6090 STRATHMOOR DRIVE SUITE #4
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City | ROCKFORD
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State | IL
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Zip | 61107-5200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SATISH PATEL
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Credential | M.D.
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Telephone | 847-321-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036126253
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License Number State | IL
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