1386748432 NPI number — SHASHIKANT AND KOKILA PATEL MD SC

Table of content: (NPI 1386748432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386748432 NPI number — SHASHIKANT AND KOKILA PATEL MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHASHIKANT AND KOKILA PATEL MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386748432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PENTWATER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BARRINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-428-3262
Provider Business Mailing Address Fax Number:
866-591-1665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 E NORTHWEST HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-358-5624
Provider Business Practice Location Address Fax Number:
847-358-5624
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SHASHIKANT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-428-3262

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036058117 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 036050325 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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