1265548077 NPI number — UMANG S PATEL M.D

Table of content: UMANG S PATEL M.D (NPI 1265548077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265548077 NPI number — UMANG S PATEL M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
UMANG
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATEL
Provider Other First Name:
UMANG
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265548077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7530 S WOODWARD AVENUE SUITE #A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODRIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-910-1177
Provider Business Mailing Address Fax Number:
630-910-4157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7530 WOODWARD AVENUE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
WOODRIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60517-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-910-1177
Provider Business Practice Location Address Fax Number:
630-910-4157
Provider Enumeration Date:
08/22/2006

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: 207R00000X , with the licence number:  036067855 , 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)

  • Identifier: 372915 . This is a "HEALTH LINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036067855 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010015757 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 10111 . This is a "ADVOCATE HEALTH PARTNERS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2201574 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363468127 . This is a "UNICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4102824 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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