Provider Demographics
NPI:1225216062
Name:VIPUL M. PATEL
Entity Type:Organization
Organization Name:VIPUL M. PATEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-659-9000
Mailing Address - Street 1:10506 CAPISTRANO LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8245
Mailing Address - Country:US
Mailing Address - Phone:219-659-9000
Mailing Address - Fax:219-659-0944
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-206-0777
Practice Address - Fax:708-206-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005006332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632074OtherBLUE CROSS BLUE SHIELD
IL213927549Medicaid