Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 36041521 | IL |
NPI | 1013036862 |
---|---|
Provider Name | Dr. Khushroo E Patel |
First Address | Northbrook, IL 60062-6204 |
Second Address | Des Plaines, IL 60016-1667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 28/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036041521 | (05) | IL |
2160211134 | BLUE CROSS (01) | IL |
363712413 | COMMERCIAL INSURANCE (01) | IL |
D12295 | (02) | IL |