Provider Demographics
NPI:1952694218
Name:PATEL, ASHISH PRANJIVAN (RSA , SA-C)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:PRANJIVAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:RSA , SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 N KESTREL AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-5767
Mailing Address - Country:US
Mailing Address - Phone:201-539-1449
Mailing Address - Fax:
Practice Address - Street 1:3622 N KESTREL AVE APT 302
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-5767
Practice Address - Country:US
Practice Address - Phone:201-539-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000389246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant