Provider Demographics
NPI:1720029929
Name:PATEL, SONAL VITHAL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SONAL
Middle Name:VITHAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N. WINFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4056
Mailing Address - Fax:630-933-4057
Practice Address - Street 1:25 N. WINFIELD RD.
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-933-4057
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002512363AS0400X
IN10000812A363AS0400X
WI2695-023363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBLUECROSS/BLUESHIELD
IL206147OtherMEDICARE PTAN (GROUP)
IL206147083OtherMEDICARE PTAN (INDIVIDUAL)
IL206147083OtherMEDICARE PTAN (INDIVIDUAL)
ILK20706Medicare PIN
WIWI2355008Medicare PIN
IL01618941OtherBLUECROSS/BLUESHIELD
ILP00313061Medicare PIN
ILQ51750Medicare UPIN