Provider Demographics
NPI:1992839062
Name:BHUPENDRA R. PATEL MD SC
Entity Type:Organization
Organization Name:BHUPENDRA R. PATEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUPENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-455-4701
Mailing Address - Street 1:9663 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2719
Mailing Address - Country:US
Mailing Address - Phone:847-455-4701
Mailing Address - Fax:847-455-7805
Practice Address - Street 1:9663 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2719
Practice Address - Country:US
Practice Address - Phone:847-455-4701
Practice Address - Fax:847-455-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093543261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093543Medicaid
IL110191689OtherRAIL ROAD MEDICARE
IL=========OtherTIN NO.
IL110191689OtherRAIL ROAD MEDICARE
IL538120Medicare ID - Type Unspecified