Provider Demographics
NPI:1174018972
Name:PATEL, MIRAL
Entity Type:Individual
Prefix:
First Name:MIRAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:847-858-2083
Mailing Address - Fax:
Practice Address - Street 1:4530 EASTGATE BLVD STE B616
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1266
Practice Address - Country:US
Practice Address - Phone:513-752-1999
Practice Address - Fax:513-752-0914
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily