Provider Demographics
NPI:1093004459
Name:PATEL, RAJ DHIRAJLAL (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:DHIRAJLAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E WOODFIELD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4717
Mailing Address - Country:US
Mailing Address - Phone:847-995-9500
Mailing Address - Fax:847-995-9501
Practice Address - Street 1:800 E WOODFIELD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4717
Practice Address - Country:US
Practice Address - Phone:847-995-9500
Practice Address - Fax:847-995-9501
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135818Medicaid