Provider Demographics
NPI:1831186105
Name:PATEL, HASUMATI D (MD)
Entity type:Individual
Prefix:MRS
First Name:HASUMATI
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 LANDWEHR RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7518
Mailing Address - Country:US
Mailing Address - Phone:847-803-3610
Mailing Address - Fax:
Practice Address - Street 1:30 N RIVER RD
Practice Address - Street 2:SUITE #103
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1283
Practice Address - Country:US
Practice Address - Phone:847-803-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14DO413049OtherCLIA
ILD89245Medicare UPIN
IL480612Medicare ID - Type Unspecified