Provider Demographics
NPI:1881777324
Name:PATEL, SURJEET D (MD)
Entity type:Individual
Prefix:
First Name:SURJEET
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 1:135 S. PALMER DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-832-1800
Mailing Address - Fax:630-832-1874
Practice Address - Street 1:135 S. PALMER DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-832-1800
Practice Address - Fax:630-832-1874
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051751Medicaid
ILD10248Medicare UPIN
IL247530Medicare PIN