Provider Demographics
NPI:1902193873
Name:PATEL, AMAR PRADIP (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAR
Middle Name:PRADIP
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W STATE ST STE 103E
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2078
Mailing Address - Country:US
Mailing Address - Phone:630-208-4412
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST STE 103E
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2078
Practice Address - Country:US
Practice Address - Phone:630-208-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110149132085R0202X
CAA1367092085R0202X
IL036-1451592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-145159Medicaid