Provider Demographics
NPI:1306846670
Name:PATEL, MANOJ RATILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:RATILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANOJKUMAR
Other - Middle Name:RATILAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2507 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5407
Mailing Address - Country:US
Mailing Address - Phone:847-802-7300
Mailing Address - Fax:815-385-3374
Practice Address - Street 1:2507 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5407
Practice Address - Country:US
Practice Address - Phone:847-802-7300
Practice Address - Fax:815-385-3374
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36113229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113229OtherSTATE LICENSE
IL1306846670OtherNPI
IL036113229Medicaid