MEDICARE: NISHA K. PATEL PA-C

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	207P00000X	Emergency Medicine Physician	PA1777	TN
2	363A00000X	Physician Assistant	PA1777	TN
3	363A00000X	Physician Assistant	085004302	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891020913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHA K. PATEL PA-C

Provider Business Mailing Address
First Line	:	9701 W HIGGINS RD STE 270
Second Line	:
City	:	ROSEMONT
State	:	IL
Zip	:	60018-4703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2077 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4003
Country	:	US
Telephone Number	:	773-886-1500
Fax Number	:	773-935-5367

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	01/14/2020

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Directions to “ NISHA K. PATEL PA-C” Practice Location

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