Provider Demographics
NPI:1396739223
Name:PATEL, MUKESH C (MD)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SAINT STEPHENS GRN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2567
Mailing Address - Country:US
Mailing Address - Phone:773-884-3380
Mailing Address - Fax:773-884-4263
Practice Address - Street 1:6084 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2773
Practice Address - Country:US
Practice Address - Phone:773-884-3380
Practice Address - Fax:773-884-4263
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-03-23
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
IL036 064813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064813Medicaid
IL036064813Medicaid
ILD 88625Medicare UPIN