Provider Demographics
NPI:1689824930
Name:PATEL, RACHEL E (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:E
Other - Last Name:FOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:890 GARFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60069
Mailing Address - Country:US
Mailing Address - Phone:847-549-1818
Mailing Address - Fax:847-680-1573
Practice Address - Street 1:890 GARFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60069
Practice Address - Country:US
Practice Address - Phone:847-549-1818
Practice Address - Fax:847-680-1573
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant