MEDICARE: KISHAN PATEL DPM

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	213E00000X	Podiatrist	135.001257	IL

General Provider Information

NPI Number	:	1689569667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHAN PATEL DPM

Provider Business Mailing Address
First Line	:	168 S FRANZEN ST
Second Line	:
City	:	BENSENVILLE
State	:	IL
Zip	:	60106-2027
Country	:	US
Telephone Number	:	630-701-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 W WILLOW KNOLLS DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-8148
Country	:	US
Telephone Number	:	309-691-5800
Fax Number	:

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

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	01/28/2026

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Directions to “ KISHAN PATEL DPM” Practice Location

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