Provider Demographics
NPI:1164875183
Name:PATEL, HIMADRI (ANP)
Entity Type:Individual
Prefix:MRS
First Name:HIMADRI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W POLK ST.
Mailing Address - Street 2:SUITE 742
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-864-7162
Mailing Address - Fax:312-864-9484
Practice Address - Street 1:1900 W POLK ST STE 742
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-7162
Practice Address - Fax:312-864-9484
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily