Provider Demographics
NPI:1083736680
Name:BHARAT K PATEL SC
Entity Type:Organization
Organization Name:BHARAT K PATEL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-524-2182
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:MEMORIAL HEIGHTS
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960
Mailing Address - Country:US
Mailing Address - Phone:618-524-2182
Mailing Address - Fax:618-524-2451
Practice Address - Street 1:12 HOSPITAL DR.
Practice Address - Street 2:MEMORIAL HEIGHTS
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-524-2182
Practice Address - Fax:618-524-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006400031OtherBCBS
IL036055925Medicaid
ILK19391OtherGROUP MEDICARE
IL1083736680OtherGROUP NPI
IL1992735526Medicaid
IL036113119Medicaid
IL692930Medicare ID - Type Unspecified
IL211861Medicare ID - Type Unspecified
IL1992735526Medicaid
ILI35669Medicare UPIN
ILD93905Medicare UPIN
IL211861Medicare PIN