Provider Demographics
NPI:1861822686
Name:PATEL, PURVI B (PAC)
Entity Type:Individual
Prefix:MRS
First Name:PURVI
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1049 EAST WILSON STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510
Mailing Address - Country:US
Mailing Address - Phone:630-482-3700
Mailing Address - Fax:630-761-8724
Practice Address - Street 1:1049 EAST WILSON STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510
Practice Address - Country:US
Practice Address - Phone:630-482-3700
Practice Address - Fax:630-761-8724
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.001599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant