Provider Demographics
NPI:1841263258
Name:PATEL, MAHINDRA D (MD)
Entity type:Individual
Prefix:
First Name:MAHINDRA
Middle Name:D
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 1:210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:IL
Mailing Address - Zip Code:61849-1027
Mailing Address - Country:US
Mailing Address - Phone:217-896-2491
Mailing Address - Fax:
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:IL
Practice Address - Zip Code:61849-1027
Practice Address - Country:US
Practice Address - Phone:217-896-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062415OtherSTATE MEDICAL LIC
IL036062415OtherSTATE LICENCE
IL687290Medicare ID - Type Unspecified