Provider Demographics
NPI:1891986907
Name:PATEL, SUBHASH J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:STE 320
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1005
Mailing Address - Country:US
Mailing Address - Phone:309-672-3140
Mailing Address - Fax:309-672-3145
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:STE 320
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-672-3140
Practice Address - Fax:309-672-3145
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-072639207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072639Medicaid
ILE39223Medicare UPIN
IL209566Medicare PIN