Provider Demographics
NPI:1821013830
Name:PATEL, REENA (PA-C)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:
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 1:675 N SAINT CLAIR ST STE 19-250
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5964
Mailing Address - Country:US
Mailing Address - Phone:312-694-2428
Mailing Address - Fax:312-695-5672
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5964
Practice Address - Country:US
Practice Address - Phone:312-694-2428
Practice Address - Fax:312-695-5672
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002660363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00447360OtherRAILROAD MEDICARE
ILP00447360OtherRAILROAD MEDICARE
ILR02303-PTAN-#209118Medicare PIN