Provider Demographics
NPI:1033259395
Name:WOODRIDGE CLINIC S.C
Entity Type:Organization
Organization Name:WOODRIDGE CLINIC S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UMANG
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-910-1177
Mailing Address - Street 1:7530 S WOODWARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3100
Mailing Address - Country:US
Mailing Address - Phone:630-910-1177
Mailing Address - Fax:630-910-4157
Practice Address - Street 1:7530 S WOODWARD AVE
Practice Address - Street 2:STE A
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-1177
Practice Address - Fax:630-910-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2023-09-12
Deactivation Date:2023-09-05
Deactivation Code:
Reactivation Date:2023-09-12
Provider Licenses
StateLicense IDTaxonomies
IL042006088207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCG1092OtherRAILROAD MEDICARE
IL2201574OtherBLUE CROSS BLUE SHIELD
ILCG1092OtherRAILROAD MEDICARE