Provider Demographics
NPI:1073809752
Name:PATEL, ROSHNI RAMESH (DPM)
Entity Type:Individual
Prefix:
First Name:ROSHNI
Middle Name:RAMESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E OHIO ST
Mailing Address - Street 2:APT 4505
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3470
Mailing Address - Country:US
Mailing Address - Phone:404-840-2354
Mailing Address - Fax:
Practice Address - Street 1:1226 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4709
Practice Address - Country:US
Practice Address - Phone:312-243-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery