Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | IL | |
N | 208D00000X | General Practice Physician | IL |
NPI | 1356567978 |
---|---|
Provider Name | Dr. Mahendragouda Patil |
First Address | Chicago, IL 60605-2719 |
Second Address | Merrionette Park, IL 60803-6302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |