Provider Demographics
NPI:1629141601
Name:PATEL, JASHBHAI M (MD)
Entity Type:Individual
Prefix:DR
First Name:JASHBHAI
Middle Name:M
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 1:30 E 15TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3459
Mailing Address - Country:US
Mailing Address - Phone:708-754-7777
Mailing Address - Fax:708-754-7701
Practice Address - Street 1:30 E 15TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3459
Practice Address - Country:US
Practice Address - Phone:708-754-7777
Practice Address - Fax:708-754-7701
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050323173000000X
IL036050323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623866OtherBLUECROSS BLUESHIELD
IL036-050323Medicaid
IL080165392OtherMEDICARE RAILROAD
ILF400196012OtherMEDICARE PTAN
ILF400196012OtherMEDICARE PTAN
ILD89239Medicare UPIN