Provider Demographics
NPI:1184859928
Name:PATEL, ANKITA PRAVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANKITA
Middle Name:PRAVIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:STE LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3543
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:SUITE 1116
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3126
Practice Address - Country:US
Practice Address - Phone:312-236-9950
Practice Address - Fax:312-236-9951
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2021-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085003408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant