Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125059221 | IL |
Y | 2080P0214X | Pediatric Pulmonologist | 036.135330 | IL |
NPI | 1437445277 |
---|---|
Provider Name | Ajanta Patel |
First Address | Burr Ridge, IL 60527-5965 |
Second Address | Chicago, IL 60637-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 15/11/2017 |