Provider Demographics
NPI:1699018317
Name:PATEL, BIRJU (MD)
Entity Type:Individual
Prefix:
First Name:BIRJU
Middle Name:
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 1:444 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1001
Mailing Address - Country:US
Mailing Address - Phone:847-853-0234
Mailing Address - Fax:847-853-0230
Practice Address - Street 1:444 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1001
Practice Address - Country:US
Practice Address - Phone:847-853-0234
Practice Address - Fax:847-853-0230
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361412202084P0804X
IL036.1412202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry