Provider Demographics
NPI:1114073095
Name:PATEL, UDIT VIJAY (DO)
Entity Type:Individual
Prefix:DR
First Name:UDIT
Middle Name:VIJAY
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TIKU
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2400 GLENWOOD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5474
Mailing Address - Country:US
Mailing Address - Phone:815-729-0700
Mailing Address - Fax:815-729-0707
Practice Address - Street 1:2400 GLENWOOD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5474
Practice Address - Country:US
Practice Address - Phone:815-729-0700
Practice Address - Fax:815-729-0707
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116060207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine