MEDICARE: MS. SARAH K 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	363A00000X	Physician Assistant	085005316	IL

General Provider Information

NPI Number	:	1487077079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH K PATEL PA-C

Provider Business Mailing Address
First Line	:	630 W LAKE ST STE 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1508
Country	:	US
Telephone Number	:	312-340-5948
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 W LAKE ST STE 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1508
Country	:	US
Telephone Number	:	312-340-5948
Fax Number	:

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

Provider Enumeration Date	:	02/02/2014
Last Update Date	:	02/27/2023

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