Provider Demographics
NPI:1710919394
Name:PATEL, CHIMANBHAI KALIDAS (MD)
Entity Type:Individual
Prefix:MR
First Name:CHIMANBHAI
Middle Name:KALIDAS
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 1:6611 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5440
Mailing Address - Country:US
Mailing Address - Phone:630-850-9505
Mailing Address - Fax:773-292-9661
Practice Address - Street 1:6555 WILLOW SPRINGS RD
Practice Address - Street 2:STE 6
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-4591
Practice Address - Country:US
Practice Address - Phone:708-579-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052687Medicaid
IL036052687Medicaid
ILD89373Medicare UPIN
ILAP9561615OtherDEA