Provider Demographics
NPI:1790703916
Name:PATEL, PARAG VITHAL (DO)
Entity Type:Individual
Prefix:
First Name:PARAG
Middle Name:VITHAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE B01, PARKSIDE BLDG.
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-723-7763
Mailing Address - Fax:847-723-2131
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 525, PARKSIDE BLDG.
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-698-3600
Practice Address - Fax:847-318-2949
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036089356207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089356Medicaid
ILL69328Medicare ID - Type Unspecified