Provider Demographics
NPI:1477759751
Name:PATEL, MINAL V (PA)
Entity Type:Individual
Prefix:
First Name:MINAL
Middle Name:V
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N RANDALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7877
Mailing Address - Country:US
Mailing Address - Phone:847-697-6464
Mailing Address - Fax:847-697-6478
Practice Address - Street 1:1530 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7877
Practice Address - Country:US
Practice Address - Phone:847-697-6464
Practice Address - Fax:847-697-6478
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant