MEDICARE: RAJUL PATEL WEST LOOP PC

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

General Provider Information

NPI Number	:	1679455505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJUL PATEL WEST LOOP PC

Provider Business Mailing Address
First Line	:	107 W LAKE ST STE 101
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-1027
Country	:	US
Telephone Number	:	630-307-3133
Fax Number	:	630-307-3134

Provider Business Practice Location Address
First Line	:	1755 W NORTH AVE STE C-101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5450
Country	:	US
Telephone Number	:	773-527-2790
Fax Number	:	630-307-3134

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	MRS. CRYSTAL BLEDSOE BARRON
Credential	:
Telephone Number	:	813-580-0028

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	07/22/2025

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