Provider Demographics
NPI:1013036862
Name:PATEL, KHUSHROO E (MD)
Entity Type:Individual
Prefix:DR
First Name:KHUSHROO
Middle Name:E
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 POST RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6204
Mailing Address - Country:US
Mailing Address - Phone:847-809-7719
Mailing Address - Fax:
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-297-3347
Practice Address - Fax:847-297-8476
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36041521208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363712413OtherCOMMERCIAL INSURANCE
IL036041521Medicaid
IL2160211134OtherBLUE CROSS
IL036041521Medicaid
ILD12295Medicare UPIN