Provider Demographics
NPI:1881856094
Name:SANJAY M. PATEL M.D. S.C.
Entity Type:Organization
Organization Name:SANJAY M. PATEL M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:MAGAN
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-463-1838
Mailing Address - Street 1:7N405 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9408
Mailing Address - Country:US
Mailing Address - Phone:773-463-1838
Mailing Address - Fax:
Practice Address - Street 1:5730 W. ROOSEVELT ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644
Practice Address - Country:US
Practice Address - Phone:773-463-1838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-29
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361184072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.118407Medicaid
K53097Medicare PIN
217036Medicare PIN