Provider Demographics
NPI:1023089307
Name:PATEL, VIKRAM B (MD)
Entity type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-1053
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:
Practice Address - Street 1:1479 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5916
Practice Address - Country:US
Practice Address - Phone:847-426-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36099069208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL81069OtherMEDICARE
IL35641715OtherBLUE CROSS BLUE SHILED OF IL
G14592Medicare UPIN
ILK49668Medicare PIN
IL35641715OtherBLUE CROSS BLUE SHILED OF IL