Provider Demographics
NPI:1265548077
Name:PATEL, UMANG S (MD)
Entity type:Individual
Prefix:
First Name:UMANG
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UMANG
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7530 S WOODWARD AVENUE SUITE #A
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-910-1177
Mailing Address - Fax:630-910-4157
Practice Address - Street 1:7530 WOODWARD AVENUE
Practice Address - Street 2:STE A
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:2006-08-22
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL372915OtherHEALTH LINK
IL036067855Medicaid
IL010015757OtherRAILROAD MEDICARE
IL10111OtherADVOCATE HEALTH PARTNERS
IL2201574OtherBLUECROSS BLUESHIELD
IL363468127OtherUNICARE
IL4102824OtherAETNA
IL4102824OtherAETNA
IL010015757OtherRAILROAD MEDICARE