Provider Demographics
NPI:1104015890
Name:OAKTON MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:OAKTON MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-567-1876
Mailing Address - Street 1:1300 GREENBROOK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5459
Mailing Address - Country:US
Mailing Address - Phone:630-830-8100
Mailing Address - Fax:630-830-8081
Practice Address - Street 1:1300 GREENBROOK BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5459
Practice Address - Country:US
Practice Address - Phone:630-830-8100
Practice Address - Fax:630-830-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116583207Q00000X
IL036090908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-60018-01Medicaid
IL558760Medicare PIN
IL=========-60018-01Medicaid