Provider Demographics
NPI:1275845372
Name:PATEL, TEJAL NANUBHAI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TEJAL
Middle Name:NANUBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16221 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7959
Mailing Address - Country:US
Mailing Address - Phone:815-588-1111
Mailing Address - Fax:
Practice Address - Street 1:16221 W 159TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7959
Practice Address - Country:US
Practice Address - Phone:815-588-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005871363AM0700X
IL085.004464363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical