Provider Demographics
NPI:1467600809
Name:PATEL, DEVANG (DO)
Entity Type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:
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 1:14855 S VAN DYKE RD
Mailing Address - Street 2:#294
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-4369
Mailing Address - Country:US
Mailing Address - Phone:630-800-2741
Mailing Address - Fax:866-223-3460
Practice Address - Street 1:14855 S VAN DYKE RD
Practice Address - Street 2:#294
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4369
Practice Address - Country:US
Practice Address - Phone:630-800-2741
Practice Address - Fax:866-223-3460
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL553180OtherMEDICARE GROUP PLAN NUMBER
IL834340OtherMEDICARE GROUP PLAN NUMBER
IL834340OtherMEDICARE GROUP PLAN NUMBER
IL553180028Medicare PIN