Provider Demographics
NPI:1508930736
Name:PATEL, RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
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 1:385 BARTLETT PLZ
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4234
Mailing Address - Country:US
Mailing Address - Phone:630-289-6024
Mailing Address - Fax:
Practice Address - Street 1:385 BARTLETT PLZ
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4234
Practice Address - Country:US
Practice Address - Phone:630-289-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057526Medicaid
IL2160975936OtherBLUE CROSS BLUE SHIELD
IL2160975936OtherBLUE CROSS BLUE SHIELD
IL678330Medicare ID - Type Unspecified