Provider Demographics
NPI:1801987565
Name:PATEL, SUNIL A (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:A
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 1:5108 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1803
Mailing Address - Country:US
Mailing Address - Phone:630-654-3023
Mailing Address - Fax:
Practice Address - Street 1:5108 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1803
Practice Address - Country:US
Practice Address - Phone:630-654-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091559207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01141465Medicaid
IL050540914OtherGROUP TAX ID
ILIL5686036OtherMEDICARE PTAN
IL050540914OtherGROUP TAX ID
ILP01141465Medicaid
G37615Medicare UPIN