Provider Demographics
NPI:1942324298
Name:PATEL, CHIRAG (DO)
Entity type:Individual
Prefix:
First Name:CHIRAG
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5419
Mailing Address - Country:US
Mailing Address - Phone:312-622-6314
Mailing Address - Fax:708-390-3739
Practice Address - Street 1:3530 W 159TH ST
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-4047
Practice Address - Country:US
Practice Address - Phone:708-333-3318
Practice Address - Fax:708-390-3739
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117215Medicaid