Provider Demographics
NPI:1629140892
Name:PATEL, BHUPENDRA R (MD)
Entity Type:Individual
Prefix:
First Name:BHUPENDRA
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 1:9663 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2719
Mailing Address - Country:US
Mailing Address - Phone:847-455-4701
Mailing Address - Fax:847-455-7805
Practice Address - Street 1:9663 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2719
Practice Address - Country:US
Practice Address - Phone:847-455-4701
Practice Address - Fax:847-455-7805
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093543Medicaid
IL036093543Medicaid
ILG59224Medicare UPIN