Provider Demographics
NPI:1811067275
Name:PATEL, PRANAV S (MD)
Entity type:Individual
Prefix:DR
First Name:PRANAV
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12800 S RIDGELAND AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-389-7663
Mailing Address - Fax:708-389-7664
Practice Address - Street 1:12800 S RIDGELAND AVE
Practice Address - Street 2:UNIT D
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-389-7663
Practice Address - Fax:708-389-7664
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036091090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G22238Medicare UPIN