Provider Demographics
NPI:1538354931
Name:PATEL, NEHA S (MPH, RD, LDN)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 W. TALCOTT AVENUE AMITA HEALTH RESURRECTION MEDICA
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-990-5164
Mailing Address - Fax:
Practice Address - Street 1:7435 W. TALCOTT AVENUE AMITA HEALTH RESURRECTION MEDICA
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-990-5164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-004692133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0451514334OtherBCBS PROVIDER ID#
IL0727500001Medicare NSC
ILK48474Medicare PIN
ILK48473Medicare PIN