MEDICARE: RAMESHKUMAR C. PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy	054011233	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2018708	OTHER		PK

General Provider Information

NPI Number	:	1174538763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMESHKUMAR C. PATEL

Provider Business Mailing Address
First Line	:	2839 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1925
Country	:	US
Telephone Number	:	773-638-6615
Fax Number	:	773-533-0945

Provider Business Practice Location Address
First Line	:	2839 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1925
Country	:	US
Telephone Number	:	773-638-6615
Fax Number	:	773-533-0945

Authorized Official
Title or Position	:	OWNER
Name	:	RAMESH PATEL
Credential	:
Telephone Number	:	773-638-6615

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/19/2017

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