Provider Demographics
NPI:1851470793
Name:PATEL, SHASHIKANT H (MD)
Entity Type:Individual
Prefix:MR
First Name:SHASHIKANT
Middle Name:H
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 1:1100 W CENTRAL RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-259-8777
Mailing Address - Fax:847-259-9994
Practice Address - Street 1:1100 W CENTRAL RD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-259-8777
Practice Address - Fax:847-259-9994
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050325Medicaid
0021608337OtherBCBS
0021608337OtherBCBS
617080Medicare ID - Type Unspecified