Provider Demographics
NPI:1639301906
Name:PATEL, NISHA N (DO)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S JEFFERSON ST
Mailing Address - Street 2:UNIT #2503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3663
Mailing Address - Country:US
Mailing Address - Phone:312-320-2247
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVENUE
Practice Address - Street 2:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-570-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.056254.207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine