Provider Demographics
NPI:1477660801
Name:PATEL, CHITTARANJAN AMBALAL (MD)
Entity Type:Individual
Prefix:MR
First Name:CHITTARANJAN
Middle Name:AMBALAL
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 1:2075 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1948
Mailing Address - Country:US
Mailing Address - Phone:219-659-7000
Mailing Address - Fax:219-659-9018
Practice Address - Street 1:2075 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1948
Practice Address - Country:US
Practice Address - Phone:219-659-7000
Practice Address - Fax:219-659-9018
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039547A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31604085OtherBCBS PROVIDER NO
IN100375920AMedicaid
IL036083269Medicaid
IN100375920AMedicaid
IL036083269Medicaid