MEDICARE: MAHINDRA D. PATEL M.D.

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	207R00000X	Internal Medicine Physician	036062415	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036062415	OTHER	IL	STATE MEDICAL LIC
2	036062415	OTHER	IL	STATE LICENCE

General Provider Information

NPI Number	:	1841263258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHINDRA D. PATEL M.D.

Provider Business Mailing Address
First Line	:	210 N MAIN ST
Second Line	:
City	:	HOMER
State	:	IL
Zip	:	61849-1027
Country	:	US
Telephone Number	:	217-896-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N MAIN ST
Second Line	:
City	:	HOMER
State	:	IL
Zip	:	61849-1027
Country	:	US
Telephone Number	:	217-896-2491
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	03/30/2022

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