Provider Demographics
NPI:1750344214
Name:PATEL, VALLABH N (MD)
Entity type:Individual
Prefix:DR
First Name:VALLABH
Middle Name:N
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 1:555 W COURT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3664
Mailing Address - Country:US
Mailing Address - Phone:815-932-4614
Mailing Address - Fax:815-932-4615
Practice Address - Street 1:555 W COURT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3664
Practice Address - Country:US
Practice Address - Phone:815-932-4614
Practice Address - Fax:815-932-4615
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078832207R00000X
IL36078832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36078832Medicaid
IL202872416OtherTAX ID
IL36078832Medicaid
IL212116Medicare ID - Type UnspecifiedGROUP
ILK20258Medicare PIN