MEDICARE: DR. KAJAL PATEL PHARM D

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	183500000X	Pharmacist	051.292916	IL

General Provider Information

NPI Number	:	1184906026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAJAL PATEL PHARM D

Provider Business Mailing Address
First Line	:	1616 N MOHAWK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5624
Country	:	US
Telephone Number	:	646-416-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5331
Country	:	US
Telephone Number	:	773-489-5607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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