Provider Demographics
NPI:1235349598
Name:PATEL, VIKAS K (MD)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:STE 310
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-936-3240
Mailing Address - Fax:815-936-3243
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:STE 310
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-936-3240
Practice Address - Fax:815-936-3243
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36114679207R00000X
IL036114679207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632011OtherBCBS
IL036114679Medicaid
IL208409003OtherMEDICARE PROVIDER #