Provider Demographics
NPI:1780668244
Name:PATEL, PARESH A (MD)
Entity Type:Individual
Prefix:DR
First Name:PARESH
Middle Name:A
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 1:1635 OAKTON PL
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2002
Mailing Address - Country:US
Mailing Address - Phone:847-635-5300
Mailing Address - Fax:847-813-0106
Practice Address - Street 1:1635 OAKTON PL
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2002
Practice Address - Country:US
Practice Address - Phone:847-635-5300
Practice Address - Fax:847-813-0106
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364312895-60018-01Medicaid
IL364312895-60018-01Medicaid
ILG28398Medicare UPIN