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NPI Code Detail

MEDICARE: KRUPA PATEL DMD

MEDICARE: KRUPA 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
1122300000XDentist019030818IL

General Provider Information

NPI Number : 1407200421
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRUPA PATEL DMD
Provider Business Mailing Address
First Line : 365 N HALSTED ST
Second Line : APT 908
City : CHICAGO
State : IL
Zip : 60661-1372
Country : US
Telephone Number : 734-756-0351
Fax Number :
Provider Business Practice Location Address
First Line : 4039 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-5219
Country : US
Telephone Number : 773-782-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2016
Last Update Date : 07/19/2016

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Directions to “ KRUPA PATEL DMD” Practice Location

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