Provider Demographics
NPI:1891704037
Name:PATEL, JAGDISH R (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAGDISHCHANDRA
Other - Middle Name:R
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2225 CRANSTON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3187
Mailing Address - Country:US
Mailing Address - Phone:608-313-9992
Mailing Address - Fax:608-313-8921
Practice Address - Street 1:2530 HAUSER ROSS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3162
Practice Address - Country:US
Practice Address - Phone:815-748-7076
Practice Address - Fax:815-748-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090465207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
207RC0000XOtherTAXONOMY