1629389333 NPI number — DR. BHUMIKA SHAH PATEL D.D.S.

Table of content: DR. BHUMIKA SHAH PATEL D.D.S. (NPI 1629389333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629389333 NPI number — DR. BHUMIKA SHAH PATEL D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
BHUMIKA
Provider Middle Name:
SHAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAH
Provider Other First Name:
BHUMIKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629389333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 E ALGONQUIN RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-640-1112
Provider Business Mailing Address Fax Number:
847-640-1107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 S GROVE AVE
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60120-6430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-608-1144
Provider Business Practice Location Address Fax Number:
847-608-1133
Provider Enumeration Date:
06/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019028336 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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