Provider Demographics
NPI:1568841427
Name:PATEL, JYOTI D (CSA)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 W TALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3707
Mailing Address - Country:US
Mailing Address - Phone:773-774-8000
Mailing Address - Fax:
Practice Address - Street 1:3743 HIGHLAND AVE STE 1002
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1594
Practice Address - Country:US
Practice Address - Phone:630-435-6107
Practice Address - Fax:630-435-6134
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000442246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant