Provider Demographics
NPI:1770570095
Name:PATEL, RAJNIKANT KANTILAL (MD)
Entity type:Individual
Prefix:
First Name:RAJNIKANT
Middle Name:KANTILAL
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 1:404 W BETHALTO DR
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1700
Mailing Address - Country:US
Mailing Address - Phone:618-377-6410
Mailing Address - Fax:618-377-6420
Practice Address - Street 1:404 W BETHALTO DR
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1700
Practice Address - Country:US
Practice Address - Phone:618-377-6410
Practice Address - Fax:618-377-6420
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073335Medicaid
E63443Medicare UPIN
IL208481Medicare ID - Type Unspecified