MEDICARE: CHANDNI K PATEL D.D.S

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	1223G0001X	General Practice Dentistry	019.030782	IL

General Provider Information

NPI Number	:	1609235118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDNI K PATEL D.D.S

Provider Business Mailing Address
First Line	:	60 E MONROE ST
Second Line	:	UNIT #4802
City	:	CHICAGO
State	:	IL
Zip	:	60603-2758
Country	:	US
Telephone Number	:	661-364-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 N PULASKI RD STE 108
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2847
Country	:	US
Telephone Number	:	661-364-5050
Fax Number	:

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

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	04/24/2017

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