Provider Demographics
NPI:1437460789
Name:PATEL, PRIYANKKUMAR PRAVINKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANKKUMAR
Middle Name:PRAVINKUMAR
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 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:
Practice Address - Street 1:509 W UNIVERSITY AVE
Practice Address - Street 2:MILLS
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1645
Practice Address - Country:US
Practice Address - Phone:217-383-6636
Practice Address - Fax:217-383-3466
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277392207R00000X
IL036141621207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine