Provider Demographics
NPI:1295168896
Name:PATEL, HETALBEN HEMAL (MD)
Entity type:Individual
Prefix:
First Name:HETALBEN
Middle Name:HEMAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HETALBEN
Other - Middle Name:BHIKHUBHAI
Other - Last Name:PRAJAPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1905 E HUEBBE PKWY
Mailing Address - Street 2:BELOIT CLINIC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:770 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2858
Practice Address - Country:US
Practice Address - Phone:608-364-2200
Practice Address - Fax:608-363-7395
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131159208000000X
WI56959-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics