Provider Demographics
NPI:1043997083
Name:PATEL, ESHA (MD,MHA)
Entity Type:Individual
Prefix:
First Name:ESHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD,MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 BAYTOWNE DR APT 24
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7926
Mailing Address - Country:US
Mailing Address - Phone:574-933-1749
Mailing Address - Fax:
Practice Address - Street 1:1050 BAYTOWNE DR APT 24
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7926
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.082825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine