MEDICARE: DR. NITIN MANUBHAI PATEL DMD

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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1316067135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NITIN MANUBHAI PATEL DMD

Provider Business Mailing Address
First Line	:	8133 RUTHERFORD DR
Second Line	:
City	:	WOODRIDGE
State	:	IL
Zip	:	60517-8050
Country	:	US
Telephone Number	:	630-985-5415
Fax Number	:	630-985-5415

Provider Business Practice Location Address
First Line	:	2556 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5216
Country	:	US
Telephone Number	:	773-782-0014
Fax Number	:	773-782-8298

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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