Provider Demographics
NPI:1700981917
Name:PATEL, KAMAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1614 W CENTRAL RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2490
Mailing Address - Country:US
Mailing Address - Phone:847-259-8777
Mailing Address - Fax:847-259-9994
Practice Address - Street 1:1100 W CENTRAL RD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2402
Practice Address - Country:US
Practice Address - Phone:847-259-8777
Practice Address - Fax:847-259-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036100655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100655Medicaid
IL110200689OtherRAILROAD MEDICARE PTAN
IL01623480OtherBLUE CROSS BLUE SHIELD
ILL77465Medicare PIN
IL01623480OtherBLUE CROSS BLUE SHIELD
IL110200689OtherRAILROAD MEDICARE PTAN