Provider Demographics
NPI:1003156373
Name:BHANU L. PATEL M D LTD
Entity Type:Organization
Organization Name:BHANU L. PATEL M D LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BHANU
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:773-478-1777
Mailing Address - Street 1:3414 W PETERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3452
Mailing Address - Country:US
Mailing Address - Phone:773-478-1777
Mailing Address - Fax:773-478-1964
Practice Address - Street 1:3414 W PETERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3452
Practice Address - Country:US
Practice Address - Phone:773-478-1777
Practice Address - Fax:773-478-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN036090924Medicaid
ILG40081Medicare UPIN