MEDICARE: MRS. MALLIKA H PATEL APN, AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	209013748	IL
2	363L00000X	Nurse Practitioner	209-013748	IL

General Provider Information

NPI Number	:	1497113708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALLIKA H PATEL APN, AGACNP-BC

Provider Business Mailing Address
First Line	:	1107 S CHERRYWOOD DR
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4549
Country	:	US
Telephone Number	:	847-258-5740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S CHERRYWOOD DR
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4549
Country	:	US
Telephone Number	:	847-258-5740
Fax Number	:

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	12/23/2025

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