MEDICARE: CHINMAY D. PATEL, D.O.

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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1902092224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINMAY D. PATEL, D.O.

Provider Business Mailing Address
First Line	:	1786 MOON LAKE BLVD STE 206
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1067
Country	:	US
Telephone Number	:	847-882-4781
Fax Number	:	847-882-7269

Provider Business Practice Location Address
First Line	:	1786 MOON LAKE BLVD STE 206
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1067
Country	:	US
Telephone Number	:	847-882-4781
Fax Number	:	847-882-7269

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHINMAY K PATEL
Credential	:	D.O.
Telephone Number	:	847-882-4781

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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