Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036134414 | IL |
NPI | 1205092939 |
---|---|
Provider Name | Ronak Patel |
First Address | Hinsdale, IL 60521-3186 |
Second Address | Hinsdale, IL 60521-3186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 05/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400203280 | MEDICARE PART B (01) | IL |