Provider Demographics
NPI:1922310234
Name:PATEL, SAMIR MAHENDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:MAHENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 W MADISON ST
Mailing Address - Street 2:#201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2638
Mailing Address - Country:US
Mailing Address - Phone:217-390-8219
Mailing Address - Fax:
Practice Address - Street 1:939 W MADISON ST
Practice Address - Street 2:#201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2638
Practice Address - Country:US
Practice Address - Phone:217-390-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028698122300000X
IL018001772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist