Provider Demographics
NPI:1528193430
Name:INTERNAL MEDICINE SPECIALISTS OF KANKAKEE SC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECIALISTS OF KANKAKEE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALLABH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-932-4614
Mailing Address - Street 1:555 W COURT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3675
Mailing Address - Country:US
Mailing Address - Phone:815-932-4614
Mailing Address - Fax:815-932-4615
Practice Address - Street 1:555 W COURT ST STE 400
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3675
Practice Address - Country:US
Practice Address - Phone:815-932-4614
Practice Address - Fax:815-932-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDE2925OtherRAILROAD MEDICARE
DE3021OtherRAILROAD MEDICARE
ILDE2925OtherRAILROAD MEDICARE