Provider Demographics
NPI:1639130271
Name:SPORTS AND OCCUPATIONAL HEALTH CONSULTANTS, LTD
Entity Type:Organization
Organization Name:SPORTS AND OCCUPATIONAL HEALTH CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-803-6021
Mailing Address - Street 1:2000 W MAIN ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1775
Mailing Address - Country:US
Mailing Address - Phone:630-803-6019
Mailing Address - Fax:866-266-0504
Practice Address - Street 1:2000 W MAIN ST
Practice Address - Street 2:SUITE L
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1775
Practice Address - Country:US
Practice Address - Phone:630-803-6019
Practice Address - Fax:866-266-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214326Medicare ID - Type Unspecified