MEDICARE: JIGISHA PATEL DDS,INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1669645016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIGISHA PATEL DDS,INC

Provider Business Mailing Address
First Line	:	8001 W DAVIS ST
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-1505
Country	:	US
Telephone Number	:	847-699-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3316
Country	:	US
Telephone Number	:	847-699-6488
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JIGISHA PATEL
Credential	:	DDS
Telephone Number	:	847-699-6488

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	04/07/2008

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