Provider Demographics
NPI:1235178831
Name:PATEL, SANJAY P (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 W ARMY TRAIL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2674
Mailing Address - Country:US
Mailing Address - Phone:630-894-8018
Mailing Address - Fax:630-894-9493
Practice Address - Street 1:473 W ARMY TRAIL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2674
Practice Address - Country:US
Practice Address - Phone:630-894-8018
Practice Address - Fax:630-894-9493
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.059377207R00000X
IL036.098432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02229935OtherBLUE CROSS & BLUE SHIELD
IL036098432Medicaid
625420OtherMEDICARE
IL036098432Medicaid
G52142Medicare UPIN