Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036140644 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036140644 | IL |
NPI | 1407134505 |
---|---|
Provider Name | Bhavisha Patel |
First Address | Sycamore, IL 60178-3192 |
Second Address | Sycamore, IL 60178-3192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 16/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036140644 | (05) | IL |
F400321084 | MEDICARE INDIVIDUAL (01) | IL |
IL6310 | MEDICARE GROUP (01) | IL |