MEDICARE: SANJAY C PATEL

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	207KA0200X	Allergy Physician	01060936	IN

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	:	1962445528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY C PATEL

Provider Business Mailing Address
First Line	:	6756 FIELDSTONE DR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5298
Country	:	US
Telephone Number	:	219-805-4244
Fax Number	:	219-513-8941

Provider Business Practice Location Address
First Line	:	9008 INDIANAPOLIS BLVD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2501
Country	:	US
Telephone Number	:	219-513-8923
Fax Number	:	219-513-8941

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/29/2020

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Directions to “ SANJAY C PATEL ” Practice Location

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