Provider Demographics
NPI:1134491871
Name:PATEL, RUPAL J (RD)
Entity Type:Individual
Prefix:
First Name:RUPAL
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3605
Mailing Address - Country:US
Mailing Address - Phone:847-331-7578
Mailing Address - Fax:
Practice Address - Street 1:219 W GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3605
Practice Address - Country:US
Practice Address - Phone:847-331-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered