Provider Demographics
NPI:1083697692
Name:PATEL, ANKIT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKIT
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2201 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5574
Mailing Address - Country:US
Mailing Address - Phone:815-725-1191
Mailing Address - Fax:815-725-2048
Practice Address - Street 1:2201 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5574
Practice Address - Country:US
Practice Address - Phone:815-725-1191
Practice Address - Fax:815-725-2048
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK08805OtherWILL CO MEDICARE PROV #
ILDC1387OtherRR MEDICARE
ILP00150113OtherRR MEDICARE PROV ID#
ILK08804OtherGRUNDY CO MEDICARE PROV #
ILP00150113OtherRR MEDICARE PROV ID#