Provider Demographics
NPI:1548230063
Name:PATEL, RAKESH R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:R
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 1:10350 HALIGUS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9545
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-802-7112
Practice Address - Street 1:10350 HALIGUS RD
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-802-7112
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112389Medicaid
IL036112389OtherSTATE LICENSE
MI0M40150090Medicare ID - Type Unspecified
IL036112389Medicaid
IA39453OtherSTATE LICENSE
MII20433Medicare UPIN
ILP00360148Medicare ID - Type UnspecifiedRR INDIVIDUAL #
IL833230Medicare ID - Type UnspecifiedGROUP #
ILK29901Medicare ID - Type UnspecifiedINDIVIDUAL #
IL420340009OtherMEDICARE PTAN