Provider Demographics
NPI:1134294853
Name:PATEL, AMRITBHAI P (MD)
Entity Type:Individual
Prefix:MR
First Name:AMRITBHAI
Middle Name:P
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 1:2625 IROQUOIS ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1232
Mailing Address - Country:US
Mailing Address - Phone:630-952-1412
Mailing Address - Fax:773-525-4022
Practice Address - Street 1:2800 N SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6117
Practice Address - Country:US
Practice Address - Phone:630-952-1412
Practice Address - Fax:773-525-4022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058256207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021609903OtherBCBS
IL036058256Medicaid
IL683310Medicare ID - Type Unspecified