Provider Demographics
NPI:1679533616
Name:PATEL, MUKESHCHANDRA D
Entity type:Individual
Prefix:DR
First Name:MUKESHCHANDRA
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 WHITE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4605
Mailing Address - Country:US
Mailing Address - Phone:630-898-0022
Mailing Address - Fax:630-898-2933
Practice Address - Street 1:475 N FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3004
Practice Address - Country:US
Practice Address - Phone:630-898-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK45560Medicare PIN
ILIL1477001Medicare PIN
ILIL2202001Medicare PIN