Provider Demographics
NPI:1255625638
Name:HASU D PATEL MD SC
Entity type:Organization
Organization Name:HASU D PATEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:HASUMATI
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-803-3610
Mailing Address - Street 1:30 N RIVER RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:847-803-3610
Mailing Address - Fax:847-803-3613
Practice Address - Street 1:30 N RIVER RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-803-3610
Practice Address - Fax:847-803-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050622207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050622Medicaid
IL036050622Medicaid
IL480612Medicare PIN