Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019.032177 | IL |
N | 122300000X | Dentist | 12013228A | IN |
NPI | 1003476771 |
---|---|
Provider Name | Palak Patel |
First Address | Tinley Park, IL 60487-8668 |
Second Address | Tinley Park, IL 60487-8668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2019 |
Last Update Date | 15/01/2021 |