Provider Demographics
NPI:1629614631
Name:PATEL, SUKETU (FNP)
Entity Type:Individual
Prefix:
First Name:SUKETU
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CARROLL SQ APT 1E
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1521
Mailing Address - Country:US
Mailing Address - Phone:224-875-0013
Mailing Address - Fax:
Practice Address - Street 1:620 CARROLL SQ APT 1E
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1521
Practice Address - Country:US
Practice Address - Phone:224-875-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF11190685207Q00000X
IL209020557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine