MEDICARE: DR. HIMADRI MAHESH PATEL D.O.

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	207Q00000X	Family Medicine Physician	036096440	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	399980	OTHER		GROUP MEDICAL PTAN

General Provider Information

NPI Number	:	1548250384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIMADRI MAHESH PATEL D.O.

Provider Business Mailing Address
First Line	:	16615 S ROUTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2921
Country	:	US
Telephone Number	:	815-609-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	16615 S ROUTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2921
Country	:	US
Telephone Number	:	815-609-6300
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	03/25/2021

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