Provider Demographics
NPI:1457502619
Name:PATEL, AMISH M (DO)
Entity Type:Individual
Prefix:DR
First Name:AMISH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NORTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:844-559-1600
Mailing Address - Fax:224-236-4900
Practice Address - Street 1:401 NORTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4264
Practice Address - Country:US
Practice Address - Phone:844-559-1600
Practice Address - Fax:224-236-4900
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004506A208100000X
IL125051773208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125813OtherLICENSE
IN02004506AOtherLICENSE NO
IN201315770Medicaid
ILIL4145001Medicare PIN
ININ1241009Medicare PIN
ILIL4144001Medicare PIN