Provider Demographics
NPI:1457346074
Name:PATEL, DEEPAK SHASHIKANT (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:SHASHIKANT
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 1:1100 W VETERANS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4728
Mailing Address - Country:US
Mailing Address - Phone:630-236-4270
Mailing Address - Fax:630-236-4271
Practice Address - Street 1:1100 VETERANS PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-236-4270
Practice Address - Fax:630-236-4271
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112492207Q00000X, 207QS0010X, 207QS0010X
WI46547020207QS0010X
OH35088025207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2673745Medicaid
WI005000513Medicare ID - Type Unspecified
OH2673745Medicaid
WII40462Medicare UPIN
OHI40462Medicare UPIN
OHPA7356501Medicare ID - Type Unspecified