MEDICARE: MAHINDRA PATEL, M.D. LTD

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	207R00000X	Internal Medicine Physician	0360662415	IL

General Provider Information

NPI Number	:	1528283116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHINDRA PATEL, M.D. LTD

Provider Business Mailing Address
First Line	:	210 N MAIN ST
Second Line	:
City	:	HOMER
State	:	IL
Zip	:	61849-1027
Country	:	US
Telephone Number	:	217-896-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N MAIN ST
Second Line	:
City	:	HOMER
State	:	IL
Zip	:	61849-1027
Country	:	US
Telephone Number	:	217-896-2491
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAHINDRA PATEL
Credential	:	M.D.
Telephone Number	:	217-896-2491

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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