MEDICARE: DR. CHINMAY KIRAN PATEL D.O.

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	207Q00000X	Family Medicine Physician	036103117	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	36-4439181	OTHER		FEIN NUMBER

General Provider Information

NPI Number	:	1336162544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINMAY KIRAN PATEL D.O.

Provider Business Mailing Address
First Line	:	1786 MOON LAKE BLVD STE 206
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1067
Country	:	US
Telephone Number	:	847-882-4781
Fax Number	:	847-233-1677

Provider Business Practice Location Address
First Line	:	1786 MOON LAKE BLVD STE 206
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1067
Country	:	US
Telephone Number	:	847-882-4781
Fax Number	:	847-233-1677

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/22/2019

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