Provider Demographics
NPI:1588607014
Name:PATEL, BHASKAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:BHASKAR
Middle Name:N
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 1:707 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-477-4773
Mailing Address - Fax:217-477-4782
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-477-4773
Practice Address - Fax:217-477-4782
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086990207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1756636OtherUNITED HEALTHCARE
IN200149600AMedicaid
IL036086990Medicaid
177407OtherPERSONAL CARE/COVENTRY
IL036086990Medicaid
IN060051874Medicare ID - Type UnspecifiedIN RAILROAD MEDICARE
1756636OtherUNITED HEALTHCARE
G53832Medicare UPIN
IN200149600AMedicaid