Provider Demographics
NPI:1710979844
Name:PATEL, SHILPA MAJMUDAR (MD)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:MAJMUDAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:FORD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3818
Mailing Address - Country:US
Mailing Address - Phone:708-753-5835
Mailing Address - Fax:708-753-5042
Practice Address - Street 1:1645 COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:FORD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3818
Practice Address - Country:US
Practice Address - Phone:708-753-5835
Practice Address - Fax:708-753-5042
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107476207R00000X
MI4301085096207RI0200X
IL036107476207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315020926OtherCONTROLLED SUBSTANCE
MI4755506Medicaid
MI4755506Medicaid
MI4755506Medicaid