Provider Demographics
NPI:1134385420
Name:PATEL, MALKAN G (DO, MS)
Entity type:Individual
Prefix:DR
First Name:MALKAN
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BISHOP CT
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6039
Mailing Address - Country:US
Mailing Address - Phone:954-644-0284
Mailing Address - Fax:866-567-9335
Practice Address - Street 1:1550 BISHOP CT
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6039
Practice Address - Country:US
Practice Address - Phone:954-644-0284
Practice Address - Fax:866-567-9335
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10455207R00000X
IL036121661207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBF911ZOtherPTAN
FL000389900Medicaid