Provider Demographics
NPI:1356567978
Name:PATIL, MAHENDRAGOUDA (MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRAGOUDA
Middle Name:
Last Name:PATIL
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 1:1225 S PLYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2719
Mailing Address - Country:US
Mailing Address - Phone:708-597-2173
Mailing Address - Fax:708-597-2315
Practice Address - Street 1:11600 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-6302
Practice Address - Country:US
Practice Address - Phone:708-597-2173
Practice Address - Fax:708-597-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207PH0002X, 207QH0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Not Answered207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice