MEDICARE: MS. ARTI PATEL PA-C

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	363AM0700X	Medical Physician Assistant	085-004545	IL

General Provider Information

NPI Number	:	1356685507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARTI PATEL PA-C

Provider Business Mailing Address
First Line	:	1624 S ELM ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-2214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4723
Country	:	US
Telephone Number	:	773-772-7858
Fax Number	:

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

Provider Enumeration Date	:	11/11/2012
Last Update Date	:	11/11/2012

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