Provider Demographics
NPI:1740826189
Name:PATEL, KRISHMA DHARESH (PA-C)
Entity type:Individual
Prefix:
First Name:KRISHMA
Middle Name:DHARESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1870
Mailing Address - Country:US
Mailing Address - Phone:630-315-8800
Mailing Address - Fax:630-315-8829
Practice Address - Street 1:1019 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1870
Practice Address - Country:US
Practice Address - Phone:630-315-8800
Practice Address - Fax:630-315-8829
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant