Provider Demographics
NPI:1275575136
Name:PATEL, JAYANTIBHAI K (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTIBHAI
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAYANT
Other - Middle Name:K
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6738 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2217
Mailing Address - Country:US
Mailing Address - Phone:708-749-2331
Mailing Address - Fax:708-749-9339
Practice Address - Street 1:6738 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2217
Practice Address - Country:US
Practice Address - Phone:708-749-2331
Practice Address - Fax:708-749-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051749207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051749Medicaid
IL036051749Medicaid
ILD89361Medicare UPIN