Provider Demographics
NPI:1336162544
Name:PATEL, CHINMAY KIRAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHINMAY
Middle Name:KIRAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 MOON LAKE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1067
Mailing Address - Country:US
Mailing Address - Phone:847-882-4781
Mailing Address - Fax:847-233-1677
Practice Address - Street 1:1786 MOON LAKE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1067
Practice Address - Country:US
Practice Address - Phone:847-882-4781
Practice Address - Fax:847-233-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103117Medicaid
36-4439181OtherFEIN NUMBER