Provider Demographics
NPI:1366598419
Name:PATEL, PRITESH J (OTR)
Entity type:Individual
Prefix:MR
First Name:PRITESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 DEMPSTER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1109
Mailing Address - Country:US
Mailing Address - Phone:847-296-9040
Mailing Address - Fax:847-296-9050
Practice Address - Street 1:1600 DEMPSTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1109
Practice Address - Country:US
Practice Address - Phone:847-296-9040
Practice Address - Fax:847-296-9050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL056.006288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24593Medicare ID - Type UnspecifiedMEMBER #