Provider Demographics
NPI:1497918361
Name:PATEL, PAYAL SHAH (DO)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:SHAH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15884 W 127TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7425
Mailing Address - Country:US
Mailing Address - Phone:630-243-7683
Mailing Address - Fax:630-243-8184
Practice Address - Street 1:15884 W 127TH ST STE H
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-7425
Practice Address - Country:US
Practice Address - Phone:630-243-7683
Practice Address - Fax:630-243-8184
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120449208000000X
IL036120449208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120449 1Medicaid
IL2220936OtherBCBS