Provider Demographics
NPI:1972619294
Name:PATEL,, VIJAYKUMAR C (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:C
Last Name:PATEL,
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VIJAYKUMAR
Other - Middle Name:C
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7530 WOODWARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3100
Mailing Address - Country:US
Mailing Address - Phone:630-910-1177
Mailing Address - Fax:630-910-4157
Practice Address - Street 1:7530 WOODWARD AVE STE A
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-1177
Practice Address - Fax:630-910-4157
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066461207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2201574OtherBLUECROSS BLUESHIELD
IL080140130OtherRAILROAD MEDICARE
IL363468127OtherUNICARE
IL409868OtherHEALTHLINK
IL036066461Medicaid
IL5606068OtherAETNA
IL40300OtherADVOCATE HEALTH PARTNER
IL036066461Medicaid
ILC44039Medicare UPIN
IL409868OtherHEALTHLINK