Provider Demographics
NPI:1588855084
Name:JAY U PATEL MD, PC
Entity Type:Organization
Organization Name:JAY U PATEL MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:U
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-726-2682
Mailing Address - Street 1:1359 W FULLERTON AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5196
Mailing Address - Country:US
Mailing Address - Phone:773-726-2682
Mailing Address - Fax:
Practice Address - Street 1:8242 CALUMET AVE
Practice Address - Street 2:SUITE 2-A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1758
Practice Address - Country:US
Practice Address - Phone:773-726-2682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058826A2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH84991Medicare UPIN
IN211520JMedicare PIN