Provider Demographics
NPI:1558718270
Name:PATEL, PRAKASH KESHABAHI
Entity Type:Individual
Prefix:MR
First Name:PRAKASH
Middle Name:KESHABAHI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E STEARNS RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-6534
Mailing Address - Country:US
Mailing Address - Phone:630-540-1285
Mailing Address - Fax:
Practice Address - Street 1:125 E STEARNS RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-6534
Practice Address - Country:US
Practice Address - Phone:630-540-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040586183500000X
IA18474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist