Provider Demographics
NPI:1912757832
Name:DHOLAKIA, KEVAL SURESH (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVAL
Middle Name:SURESH
Last Name:DHOLAKIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HASTINGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1937
Mailing Address - Country:US
Mailing Address - Phone:630-965-0918
Mailing Address - Fax:
Practice Address - Street 1:154 HASTINGS MILL RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1937
Practice Address - Country:US
Practice Address - Phone:630-965-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.010245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant